THE LIBRARY OF THE UNIVERSITY OF CALIFORNIA LOS ANGELES MEDICAL ELECTRICITY: A PRACTICAL TREATISE APPLICATIONS OF BLECTRICITY TO MHDICINE AND SURGERY. BY ROBERTS BARTHOLOW, A.M., M.D., LLD., PROFESSOR OF MATERIA MEDICA, GENERAL THERAPEUTICS, AND HYGIENE IN THE JEFFERSON MEDICAL COLLEGE OF PHILADELPHIA; FELLOW OF THE COLLEGE OF PHYSICIANS OF PHILADELPHIA; MEMBER OF THE AMERICAN PHILOSOPHICAL SOCIETY; HONORARY MEMBER OF THE SOCltTli MEDICO-PRATIQUES DE PARIS, OF THE MEDICAL AND CHIRUKGICAL FACULTY OF MARYLAND, OF THE NEW YORK AND OHIO STATE MEDICAL SOCIETIES, OF THE CINCINNATI ACADEMY OF MEDICINE, AND OF 1 HE NEW YORK NEUROLOGICAL SOCIETY; AUTHOR OF "a PRACTICAL TREATISE ON MATERIA MEDICA AND THERAPEUTICS," OP "a TREATISE ON THE PRACTICE OF MEDICINE," AND OF "A MANUAL OF HVI'ODERMATIC MEDICATION," ETC. THIRD EDITION, ENLARGED AND IMPROVED. WITH ONE HUNDRED AND TEN ILLUSTRATIONS. PHILADELPHIA: LEA BROTHERS & CO. 1887. Entered according to Act of Congress, in the year 1887, l)y LEA BROTHERS & CO., in the Office of the Librarian of Congress, at Washington. DORNAN, I'RINTKK TO BRIGADIER-GENERAL JOHN MOORE, M.D., SURGEON-GENERAL, U. S. ARMY, THE ASSOCIATE OF EARLY YEARS ON THE FRONTIER IN THE ARMY MEDICAL STAFF, AND THE LIFE-LONG FRIEND, Ijedicale this jjolumc AS AN EXPRESSION OF THAT REGARD WHICH THE PROGRESS OF TIME HAS NOT LESSENED, AND AS A TESTIMONY OF MY ADMIRATION OF THE CAREER WHICH HAS ILLUSTRATED EVERY GRADE IN THE MEDICAL STAFF WITH THE HIGHEST RECTITUDE OF CONDUCT AND AN ADMIRABLE FIDELITY TO DUTY. PREFACE TO THE THIRD EDITION. It would be a mere afifectation of indifference which I am far from feeling, to refrain from the expression of my gratification that the pub- lishers of this work have called on me to prepare a new edition. My gratification is the greater in that the sale of this, and other, works on Medical Electricity, afford indubitable evidence of growth in the appre- ciation of electricity as a remedial agent, by the medical profession in general. That this force should be utilized in therapeutics, just as any drug is employed as a remedy, is a fact of the highest importance. Besides the addition to the resources of the practitioner thus obtained, it is the one mode by which electricity may be divorced permanently from charlatanry, which has profited by it commercially, whilst it has im- paired professional confidence in its utility. If electricity has real value as a remedy for disease, it is clear no physician is justified on moral grounds in ignoring it, and on commercial grounds, to neglect the employment of so useful an agent, must be regarded as an act of exceeding unwisdom. To utilize electricity has become a necessity of the times ; hence, a full understanding of its principles and appliances is imperative. The accumulation of clinical facts and experiences, and the improvements in apparatus, have so simplified and facilitated the practical adaptations of the science and art to the work of the physician, that the least qualified members of the profession may achieve a considerable measure of success in practical electro-therapeutics, although unacquainted with the niceties of electrical science. As stated in the preface to the first edition, one of my purposes in preparing the work was to afford some aid in generalizing medical elec- tricity, and that I have been able to contribute in any degree to this object has quite resigned me to the labor of composition. When Vlll PREFACE TO THE THIRD EDITION. medical electricity comes to take its rightful place as one of our approved remedies, rather than a panacea, juster conceptions of its true powers will be formed, and the inevitable failures which must often happen to the universal remedy will be prevented, and its good name preserved from the odium of unperformed promises and unsatisfied expectations. To that desirable consummation should be directed the influence and efforts of all. The new material which appears in this edition is chiefly practical in character. The most important additions have been made to the thera- peutical sections. A fuller account has been given of the appliances for electrical illumination, and the apparatus used in galvano-causty. The comparatively new subjects of galvano-faradization and electric baths, have been more or less fully considered. To my indulgent readers I again beg to repeat the assurance of my gratitude for the favor with which they continue to regard my several contributions to practical medicine, and especially for the approval they have so abundantly bestowed on this my newest volume. R. B. Philadelphia, 1527 Locust Street. PREFACE TO THE SECOND EDITION. As a considerable edition of this treatise was exhausted within a year, and the demand continuing unabated, I feel that I did not miscon- ceive the need of the time for a practical work on Medical Electricity. My purpose was to prepare a work from the practitioner's, rather than the merely scientific, standpoint. In the present edition the same conception of the subject continues paramount ; and in that spirit I have made many additions and improvements to render the work more useful to those for whom it is intended. At the same time, in response to what seems to me an increasing desire for scientific treatment, I have developed more fully the modern methods of ascertaining and expressing current strength, tension, resistances, etc. I have, also, entered more fully into the polar method, and into the action and uses of the magnet. Notwithstanding an increase in the number of lines to the page, and the condensation of the matter new and old, the work has been enlarged by the addition of thirty pages. Thus improved, I may be permitted to hope that the new edition will continue to enjoy the favor so largely bestowed on the first. Roberts Bartholow. Philadelphia, 1509 Walnut Street. PREFACE TO THE FIRST EDmON. In my annual course of Lectures on Materia Medica and Thera- peutics, I have discussed, more or less fully, the subject of electricity as a therapeutic agent. It happened in this way that my attention was called to the need of a suitable text-book. That there are excel- lent works on medical electricity is undeniable ; but some of them are too voluminous, others too scientific, and not a few wanting both in fulness and in accuracy. I have attempted in the preparation of this work to avoid these errors; to prepare one so simple in statement, that a student without previous acquaintance with the subject may readily master the essentials ; so complete as to embrace the whole subject of medical electricity, and so condensed as to be contained in a moderate compass. I have endeavored to keep constantly in view the needs of the two classes for whom the work is prepared — students and practitioners. I have assumed an entire unacquaintance with the elements of the subject as the point of departure — for I am addressing those who have either failed to acquire this preliminary knowledge, or having acquired it, find that after the lapse of years it has become misty and confused. In the account of electrical phenomena, I have adhered to the modes of expression with which the medical electrical text-books have made us familiar. The time has not come, it seems to me, to adopt the terms and explanations now employed by practical electricians : it is a transition period in which both the old and the new should have a measure of recognition. I have, accordingly, followed the usual course in the account of electrical principles and instruments, intro- ducing also the new terms — the units — by which the electro-motive force, quantity, capacity, and resistance are expressed. Electricity as applied to practical arts — to lighting, heating, telegraphy, and mechanical work generally — demands different treatment, especially as xii PREFACE TO THE FIRST EDITION. respects the means and methods of exact measurement, from that re- quired in the presentation' of its medical uses. Although it is true that exacter methods of stating current strength, resistances, etc., are desirable in the medical applications of electricity, we are not yet in a position to avail us of the results achieved in the applied science, for the human body is an altogether more uncertain quantity than a copper wire of given length and sectional area. Furthermore, a proper statement of the various questions in the electrical science of to-day, requires the use of the higher algebra and the calculus — an amount of mathematical knowledge not universally possessed by medical students and practitioners. I have, however, entered somewhat into the consideration of the polar method, especially as developed by Erb and Brenner, and have described the mode in which the reactions are now expressed. An entirely novel subject is the adaptation of the Toepler-Holtz electrical machine, by simply connecting the interior and outer coating of the condensers, for the production of nerve and muscle reactions just like those of the primary faradic current. I know of no publication in which this novel fact has been stated.^ It accord- ingly opens up, for the fipst time, an important field for future investiga- tion and research. This book, then, must be regarded as the exposition of electricity for remedial purposes, made by a medical practitioner for the use of other medical practitioners. No claim is made on the ground of pure science. It is believed, however, that the work makes an adequate presentation of the subject, regarding electricity as a remedial agent — as one of the means employed for the treatment and cure of disease. Roberts Bartholow. Philadelphia, 1509 Walnut Street, March, 1881. 1 As this work is going through the press, my attention is called to a paper by Dr. W. J. Morton in the New York Medical Record for April 9. CONTENTS PAGE .ODUCTION • 17 Modes of the force • 17 Matter and force . 18 Work . 18 Energy and potential . 18 PART I. ELECTRO-PHYSI CS CHAPTER I. MAGNETISM. Magnets . Natural . Artificial . Lode-stone North polarity South polarity Law of polarity Magnetic induction Forms of magnets Coercitive force Magnetic field Dip and inclination 21 21 21 21 22 22 22 23 24 24 25 25 CONTENTS. CHAPTER 11. STATIC ELECTRICITY Vitreous Resinous Theory of Dufay Conductors Insulators Induction Electrical machines Leyden jar Battery of Leyden jars PAGE 27 27 27 28 28 29 30 32 33 CHAPTER III. DYNAMICAL ELECTRICITY- Galvanism Voltaic electricity . Galvanic element Generating plate Conducting plate Conjunctive wire Galvanometer . Astatic . Difference of potential Volume of the current Direction of the current Intensity. Resistance Ohm's law Measures of capacity . The Volt The Ohm The Ampere . The Farad Measurement of current strength Voltameter Measurement of resistances 35 35 35 36 36 37 37 37 38 38 38 39 39 39 39 39 40 40 40 41 41 42 CONTENTS. XV Rheostat Electrical discharge Electrolysis Electrolyte Anode . Cathode . Anions . Cations . PAGE 43 44 45 45 45 45 45 CHAPTER IV. FORMS OF GALVANIC COMBINATIONS. Single fluid battery Smee's element Grenet's element Stohrer's battery Partz portable battery Grove's battery Bunsen battery Daniell's battery Siemens and Halske's battery Hill's gravity battery Leclanche element . Partz cautery battery Arrangement of cells Permanent batteries Portable batteries . Key or pole board . Resistance coils Cabinet battery Remak's battery 45 46 47 48 49 50 50 51 52 53 54 55 56 58 58 60 60 61 62 Oersted's discovery Faraday's discovery Induction Ruhmkorff coil CHAPTER V. ELECTRO-MAGNETISM. 65 65 66 67 XVI CONTENTS. Faradic battery The couplet The coil .... The interrupter Mechanism of a faradic battery Principles of the action . The Du Bois-Reymond battery 67 68 68 69 70 71 73 CHAPTER VI. MAGNETO-ELECTRICITY. The mechanism ..... 74 The magnet 74 The coil ...... 75 Duchenne's battery .... • 75 The commutator ..... 76 The dynamo ...... 77 CHAPTER VII. ELECTRO- MAGNETIC AND MAGNETO-ELECTRIC BATTERIES FOR MEDICAL USE, Kidder's battery Flemming's battery Hall's battery Gaiffe battery Combination battery Galvano-faradization The electric bath Monopolar baths , Dipolar baths 79 80 80 81 82 84 84 85 85 CHAPTER VIII. CARE OF BATTERIES, GALVANIC AND FARADIC : MANIPULATION. How to care for batteries ........ The poles ........... Strength of application ......... 90 90 CONTENTS. XVll Moistened electrodes Dry electrodes Stabile and labile . Direct or descending Inverse or ascending General electrization Diffusion Derived currents PAGE 91 91 92 92 92 92 93 93 PART II. ELECTRO-PHYSIOLOGY Electric eel Muscle currents Nerve currents Electrotonic state . Electro-capillarity . CHAPTER I. ANIMAL ELECTRICITY, 95 97 99 CHAPTER II. ACTION OF THE GALVANIC CURRENT ON MOTOR, SENSORY, AND MIXED NERVES. Muscular irritability Muscle and nerve preparation Muscle curve . Descending currents Ascending currents Electrotonus . Anelectrotonic Catelectrotonic Induced contractions Voltaic alternatives lOI 102 104 104 '05 106 106 106 io8 108 XVlll CONTENTS, CHAPTER III. ACTION OF INDUCED OR FARADIC CURRENTS ON MOTOR, SENSORY, AND MIXED NERVES .... 109 CHAPTER IV. ACTION OF GALVANIC AND FARADIC ELECTRICITY ON THE SYMPATHETIC AND VASOMOTOR SYSTEMS. Contractions of non-striated muscles Vermicular contractions . The influence of current strength . no no 112 CHAPTER V. ACTION OF GALVANIC AND FARADIC ELECTRICITY ON MUSCLE STRIATED AND NON- STRIATED. Muscular (Hallerian) irritability ...... 113 Galvano-tonic contractions ....... 114 Action of no-nstriated 114 Faradic excitability ........ 115 Galvanic excitability ........ 115 Normal formulae 116 Symbols ........... 116 CHAPTER VI. ACTION OF GALVANIC AND FARADIC CURRENTS ON THE CEREBROSPINAL AXIS. Does the current traverse the brain ? Spinal effects ..... Cerebral effects of galvanism . 118 120 120 CHAPTER VII. ACTION OF GALVANIC AND FARADIC CURRENTS ON THE PNEUMOGASTRIC NERVE AND HEART CONTENTS. XIX CHAPTER VHI. ACTION OF ELECTRICITY ON THE SPECIAL SENSES. Brenner's formulai ........ PAGE PART III. ELECTRO-DIAGNOSIS. CHAPTER L ELECTRO-CONTRACTILITY. Methods Muscular reactions Nerve reactions Spinal reactions Normal formulae Disease formulse Faradic excitability- Galvanic excitability Reactions of degeneration 125 127 130 132 132 ^33 133 133 134 CHAPTER II. ELECTRO-SENSIBILITY. Methods of diagnosis of electro-sensibility Methods of diagnosis of eye and ear sensibility- Methods of diagnosis of gustatory sensibility Methods of diagnosis of cutaneous sensibility Methods of diagnosis of hysterical paralysis . Feigned affections ...... 136 136 136 137 138 139 CONTENTS. PART IV. ELECTRO-THERAPEUTICS. CHAPTER I. MAGNETO-THERAPY THE THERAPEUTICAL APPLICATIONS OF THE MAGNET. History ....... Physiological effects of the magnet . Form of magnet ..... Therapeutical applications of the magnet 141 142 145 CHAPTER II. STATIC ELECTRICITY ITS METHODS AND USES. History ........ The appliances of statical electricity The Toepler-Holtz machine .... General franklinization ..... Nerve and muscle effects .... Therapeutical applications of static electricity 148 152 153 154 155 156 CHAPTER III. ELECTRO-THERAPEUTICS. Galvanism in cerebral diseases Galvanism in cerebral congestion Galvanism in cerebral anaemia Galvanism in psychical disorders 158 159 160 163 CHAPTER IV. ELECTRICITY IN SPASM AND CRAMP. Epilepsy . Chorea . Histrionic spasm 166 167 167 CONTENTS. XXI PAGE Blepharospasm . i68 Torticollis . i68 Stricture of oesophagus . 169 Singultus 169 Spasmodic asthma . 170 Tetanus .... . 170 Writer's cramp CHAPTER V. . 170 ELECTRICITY IN THE PARALYSES. Spinal paralyses 173 Paraplegia . 173 Chronic myelitis . 175 Infantile paralysis . . 178 Pseudo-hypertrophic • 179 Progressive muscular atrophy 183 Sclerosis of the cord . 185 Peripheral paralyses 187 Facial paralysis 187 Muscular paralysis . 195 Neuritis 198 Multiple .... 198 General multiple 198 Paralysis of ocular muscles 199 Hysterical paralyses 200 Hystero-epilepsy 203 Diphtheritic paralysis 204 Lead paralysis . . . . 205 CHAPTER VI. ELECTRICITY IN THE TREATMENT OF PAIN. Neuralgia of the fifth nerve Cervico-brachial Intercostal Sciatic Lumbago Myalgia Rheumatism 209 209 210 212 213 213 214 CONTENTS, Visceral neuralgia . Hemicrania Angina pectoris Gastralgia PAGE 219 219 CHAPTER VII. ELECTRICITY IN ANAESTHESIA AND ANALGESIA. Anosmia .... Amblyopia .... Amaurosis .... Anaesthesia of the auditory nerve 221 221 222 222 CHAPTER VIII. ELECTRICITY IN THE VASOMOTOR AND TROPHIC NEUROSES. Exophthalmic goitre Skin diseases . CEdema . Ascites . 224 227 228 228 CHAPTER IX. ELECTRICITY IN CONSTITUTIONAL DISEASES. Syphilitic affections Chronic rheumatism Plumbic affections . 228 229 230 CHAPTER X. ELECTRICITY IN LOCAL, OTHER THAN NERVOUS DISEASES. Naso-pharyngeal catarrh Vomiting Atonic dyspepsia . Constipation . Imi)action of the intestines 232 233 233 234 234 CONTENTS. Respiratory depression Cardiac depression Uterine hemorrhage Chronic metritis Uterine inertia Extrauterine pregnancy Amenorrhoea . Irritability of the bladder Impotence Genital irritation Urethral applications Electrodes for various uses PAGE 236 236 =!37 237 238 240 242 243 243 244 244 245 PART V ELECTRICITY IN SURGERY CHAPTER I. ELECTROLYSIS. Definitions The battery . The needles . Aneurism Cystic tumors Polypi . Stricture of the urethra Fibroid tumors Hydrocele 249 251 253 254 262 263 263 265 266 CHAPTER II. MEDICAL ELECTRIC HEATING AND LIGHTING. Galvano-causty Batteries Galvano-caustic electrodes 267 268 272 XXIV CONTENTS. Galvano-caustic loop Gal vano- caustic knife The electric osteotome Galvano-cautery The medical electric light Storage cells . Plante's ceil . Trouve's polyscope Larynx reflectors . Electric laryngoscope Adams's electric laryngoscope The S. S. White Co.'s laryngoscope The S. S. White Co.'s otoscope 273 276 277 279 282 282 284 285 286 287 288 289 291 PART VI THERMO-ELECTRICITY, CHAPTER [. PRINCIPLES. Galvanometer Thermo-electric pile Thermo-electric multiplier Lombard's apparatus 294 295 296 297 CHAPTER IL MEDICAL USES OF THE THERMO-ELECTRIC PILE. Variations of temperature, normal Variations of temperature, pathological . 298 299 Index ............ 300 A TREATISE ON MEDICAL ELECTRICITY. INTRODUCTION. MODES OF THE FORCE. Electricity Is one of the physical forces — a mode of manifestation of energy, kinetic and potential — and is con- vertible into or is correlated with the other modes of force. It is manifested in several forms ; as — Magnetism. Static Electricity ok Franklinism : Vitreous, Resinous. Dynamic Electricity : Galvanism, Faradism : Electro-rnagnetism, Magneto-electricity. Thermo-electricity. Maenetism differs from the other modes of electrical force in that the energy of the excited body is always present. The pieces of magnetic iron ore, or of steel in which the magnetic property has been induced, are always in a condition to exhibit their special powers, z. e., suspended and free to move, always assuming a uniform direction, or 18 INTRODUCTION. attracting certain bodies in their neighborhood. Static electricity is developed from a material — glass or resin — which is entirely quiescent until excited by friction. Gal- vanism is produced by chemical action or by contact which causes electrical separation, and faradism is the result of induction by galvanism or by mechanical power. When friction or chemical action ceases, the resulting phenomena subside. Medical electricity is the application of the science of electricity to the requirements of medical practice, and is concerned with all of these modes or manifestations of electrical energy. There are certain terms now employed in giving mathe- matical expression to the facts of physical science, and some knowledge of them is therefore necessary in the study of electricity. Matter 2.nA force are terms in frequent use. From the point of view of physics, matter is a something by and throug-h which the forces act. Force is defined to be that o which can change any body's state of rest or motion. The unit of force is called a dyne. The unit of mass is a cubic centimetre of distilled water at 4° Cent. This mass is the gramme, and on it is based the decimal system. Work is defined as overcoming resistance through space. When a weight is raised, work is done in over- coming the force of gravity through the space over which the weight is moved. The Enorfish unit of work is the foot-pound — that is, the work done in raising one pound one foot in height. The Continental unit of work, called the Erg, is the work done in moving a gramme, through the space of a centimetre, against a unit of acceleration. Energy is the capacity for doing work, and may be kinetic, when the body employed is in actual motion, or it may be pote^itial, when it has the power to do work, or is INTRODUCTION. 19 in a condition that work may be recovered from it. Thus, when a spring is bent, or weight raised, and is in a posi- tion to act, potential energy is acquired by the work done in bending the spring or in raising the weight. Potential becomes actual or kinetic energy when the spring or weight is released to move some other body, or to do work of some kind. Difference of potential between any two points is the work done in carrying a unit of mass from one point to the other. Zero potential is the point chosen as a standard of reference. Any place which requires work to be done to bring the unit of mass from the zero point to it will have positive potential, and any place which requires work to be done to brino- the unit of mass from it to the zero point has negative potential. PART 1. ELECTRO-PHYSICS, CHAPTER I. MAGNETISM. The term " magnet " was originally applied to certain iron ores possessing peculiar properties, and which were found near the ancient city of Magnesia, in Asia Minor, In one respect this native ore differed from all others ; it had the power of attracting to itself other small particles of iron. It was subsequently discovered that the property possessed by some natural iron ores could be communi- cated, under certain conditions, to other pieces of iron ; whence the distinction into natural and artificial magnets. The natural magnet is also called lode-stone, or, more properly, lead-stone, because of the power it possesses of drawing, or leading to motion, certain substances sub- jected to its influence. If a permanent magnet be made to approach a bar of soft iron, suspended at its centre and free to move, the bar is attracted and moves toward either end of the magnet. If now a bar-magnet is substituted for the soft iron, and suspended to move freely, when another permanent magnet is made to approach, it is found that, whilst one extremity of each is attracted, the other extremities are not attracted — are, on the contrary, repelled, and they cannot be made to approximate to each other. Moreover, we observe that the suspended magnet, Fig. I. 22 ELECTRO-PHYSICS. left to itself, invariably assumes a certain position. If disturbed, after a period of oscillations, it finally settles to rest in the one position — one extremity pointing to the north, the other to the south. Further investigations demonstrate that the peculiar properties of the magnet reside only in the extremities, and that they disappear at the centre, which is hence known as the neutral point or magnetic equator, etc. These extremities of the magnet are termed poles, and the property exhibited by them is called polarity (Fig. i). That ex- tremity of the magnet which points to the north is called the north pole — or the marked extremity, because it always contains a mark to designate it ; the other end is called the south pole. If we bring the north pole of one permanent maenet into the neio-hborhood of the south pole of another permanent mag- net, they immediately attract each other and strongly adhere, so that some force is required to separate them. On the other hand, if we approximate the north or the south poles of the two magnets, they manifest a mutual repugnance and fly from each other. Hence the law: Like poles repel, unlike poles attract. The influence of one magnet on another is also exhibited before they are actually in contact — even when a consider- able space intervenes — but it is the more powerful the nearer they approximate to each other. This influence is expressed by this law : The mag^ietic force is exerted in- versely as the square of the distance. When a permanent magnet is made to approach a bar of soft iron, the latter is attracted, because the opposite polarity is diverted to that extremity of the iron nearest the magnet. In this fact we have an exhibition of the phenomenon of induction. Mag- netism is a force existing in the bodies capable of its mani- A permanent magnet. MAGNETISM. 23 festations, under ordinary circumstances in a quiescent state. When the magnet is brought near to the bar of soft iron, the neutral magnetic condition of the iron is dis- turbed, and it assumes a polar state, north polarity mag- netism accumulating at one extremity, and south polarity magnetism at the other. When the permanent magnet is withdrawn, these evidences of polarity cease, and the mag- netism in the bar of soft iron resumes its neutral or unex- cited condition. By the approach of the north or marked pole of the magnet, the opposite magnetism (or south) is induced at the extremity of the bar nearest the magnet. Similar phenomena occur in static electricity — for example, when the excited electric approaches the suspended pith- ball. The production of two instantaneous currents in a coil of fine wire, about the conjunctive wire of the galvanic battery, is another example of the principle of induction. Fig. 2. Forms of horseshoe magnet. When a permanent magnet is broken into two pieces, each is found to possess north and south polarity ; and if these two pieces are broken into others, each remnant is 24 ELECTRO-PHYSICS. found to be a complete magnet. The subdivision may be carried on still further with the same effect. This result is explained by supposing that each separate molecule of iron is endowed with the two magnetisms — with north and south polarity. Magnets are made in the form of a bar, or of a needle, and of a horseshoe, the magnetic property being the same in either case (Fig. 2). In the preparation of a magnet the hardest steel is used. It ought to be so hard as not to be attacked by a good file. Steel is employed for this purpose, and the hardest steel, because it possesses in a higher degree than ordinary iron the coercitive force — or the power to retain the magnetic polarity after it has been imparted to it. In the process of magnetizing a steel bar, the single or double touch may be employed. By the single touch, over that extremity which is intended to have north polarity, the south pole of a magnet is rubbed, be- ginning at the centre of the bar and stroking it outwardly, and coming back to the point of starting, through the air. The other extremity of the steel bar is treated in the same way with the north pole of the magnet. The double touch consists in applying two magnets, at an angle of 15° to 20° with the bar, beofinnino- at the centre and strokino- both extremities simultaneously. If the strength of the magne- tizing- magnet is increased, the magnetized steel has the strength of its polarity increased also. There is, however, a limit to the extent of the magnetization, for when the bar has become saturated, all the force above this tempo- rarily imparted to it, wears off. So intense and powerful is the force thus developed in a magnet, that some pos- sessing in a high degree the coercitive property have been made to bear a weight twenty times greater than their own, but twelve and thirteen times greater are points very seldom exceeded, and as a permanent state, considerably below that is usual. Certain precautions are necessary to MAGNETISM. 25 preserve the activity of magnets. The poles, both of the straight and horseshoe form, should be connected by a bar of soft iron. Notwithstanding steel possesses in a high degree the coercitive force, the magnetic property may be easily destroyed. A blow, scratching the surface, rubbing with any hard substance, especially heating the magnet, injure its magnetic effect. It is injurious to lay the magnet on iron. A magnet placed in any position exerts a certain influ- ence on surrounding objects. The area over which the magnetic force acts is called the magnetic field, and the supposed lines on which the influence proceeds across the field are called the lines of force. When a magnet is suspended or balanced on a pivot and free to move in any direction, it assumes, as has been stated, the position of north and south polarity, or boreal and austral (Fig. i). When a magnetic body is suspended between the poles of a permanent magnet, it assumes an axial position. The earth is a great magnet, having its southern pole in the neighborhood of the geographical north pole ; consequently, the north pole of the magnet is attracted toward the north — unlike poles attract. It is this remarkable property which renders the needle of the com- pass so important to mariners. The needle does not always point due north. The angle which the north pole of the needle makes with a horizontal plane is called the "Dip" or "Inclination," and the angle which it makes with a vertical plane due north from the centre of the needle is called the " Declination." At the equator the needle is nearly horizontal, but as either pole of the earth is approached, it dips until at certain points it stands vertical. The declination of the needle from 1580 to 1657 was easterly in London, and from 1657 to 181 5 was westerly, and since the last-men- tioned date has been going easterly again toward the 26 ELECTRO-PHYSICS. astronomical meridian. From the time of the discovery of the inchnation of the needle up to 1723 the inclination increased ; from that time to the present it has decreased. There seems to be a decennial period in the more considerable disturbances of the declination, and are apparently determined by the sun spots. There are oscillations diurnal, lunar, etc. For certain purposes it is necessary to employ a mag- netic needle, which is so constructed as to be uninfluenced by the directive force of the earth's magnetism, but to possess all other properties of the magnet. This is effected by combining two magnets into one, the poles being opposed. Such a combination is called an astatic needle. The earth's magnetism being exerted on the combination, if the two needles composing it are of equal power, the effect on one pole is exactly equalled by that on the other, and hence no movement takes place ; but such a needle is readily responsive to the influence of an electric current passing through a closed circuit in its neighborhood. CHAPTER II STATIC ELECTRICITY. Static, frictional, and Franklinic are the terms applied to this force. It is static, because the electricity is restrained in a condition of high tension ; it is frictional, because developed by friction of certain substances, as glass and resin ; and it is Franklinic, because Franklin demonstrated the identity of frictional with terrestrial electricity. The phenomena of static electricity are illustrated by simple means. If a glass rod is rubbed with a silk handkerchief. STATIC ELECTRICITY. 27 it is found to possess a new property. That portion of the rod subjected to friction, if approached near a pith- ball suspended' by a silk thread, attracts it, and after a short time in contact with the rod the ball is repelled. The friction develops electricity, the particles of which are self-repellant, since as soon as the pith-ball is charged it is continually repelled by the glass rod. This is called vitreous electricity, because obtained by the friction of glass. If now a piece of resin be rubbed with flannel, and brought near to the charged pith-ball, the latter will be at once attracted. After a time becoming charged with electricity from, resin, the pith-ball will be repelled, and whenever approached by the excited resin so long as it is charged by its electricity, repulsion will occur. We learn from this experiment that there is another form of elec- tricity — the resinous, and that the particles of this are also self-repellant. If we reverse this experiment, and charge the pith-ball first with resinous electricity, we find that the ball is presently repelled, and that when in this condition an excited g-lass rod is broueht near it, the ball is at once attracted. It is clear, therefore, that the two electricities attract. From these observations we deduce the law : Unlike electricities attract, like electiHcities repel (Fig. 3). Fig. -x. Unlike electricities attract — like, repel. According to the theory of Dufay, which is now gen- erally held, there are two electrical fluids — the positive and the negative, or vitreous and resinous. These are generally distributed, mixed together, neutralizing each other, and perfectly quiescent, when so united. By certain 28 ELECTRO-PHYSICS. processes — friction, chemical action, motion, heat, etc. — a separation of the two electricities takes place, but there must be present just as much of the one as of the other. In rubbing the glass rod, the glass is excited positively, but the silk is excited in the same proportion, by negative electricity. These two forms of electricity are called respectively "positive" and "negative," and the signs + and — are used to designate them, the + sign being arbitrarily applied to vitreous electricity. With regard to electrical action bodies are divided into two great groups, conductors and hisulators. They may be arranged as follows : o Conductors. Insulators. Metals, Caoutchouc, Charcoal, Silk, Graphite, Glass, Acids, Wax, Water, etc. Sulphur, Resins, Shellac, etc. This sharp division into two groups is not always pos- sible. In some instances, conductors of the least perfect kind become insulators ; and poor insulators become tol- erable conductors. The very best conductor offers some resistance to the passage of the current. Circumstances affect the position of these bodies. Dry air is a non-con- ductor, but if moisture is present, it becomes a conductor. Glass is a non-conductor in the ordinary state, but when heated to redness becomes a good conductor. A con- ductor is said to be insulated when mounted on some non-conductor or insulator. For example, a brass rod mounted on grlass or caoutchouc is insulated. Without insulators, electricity could not be collected to exhibit the various phenomena of which this force is capable. STATIC ELECTRICITY. 29 Electricity is not only transmitted by conduction, but it operates through the intervening molecules of air, by induction. Thus, if an excited g-lass rod is brought near to the gold-leaf electrometer, the leaves diverge. There is no conduction ; the rod is not in contact with the brass knob of the electrometer, but the gold leaves separate as soon as the rod approaches, so that an influence of some kind is exerted througrh the air. When the excited elass rod approaches suspended pith-balls, they move toward the rod, for on that side of the balls nearest the rod the opposite or resinous electricity accumulates, whilst the vitreous flows to the other side. In other words, the excited glass rod induces the opposite, or negative, or resinous electricity on the side of the pith-balls nearest it. As in accordance with the law, unlike electricities attract, the pith-balls fly and attach themselves to the rod, until charged with vitreous electricity, when they are repelled. Electricity accumulates upon the surface of bodies, and not in their interior. This fact is demonstrated by the following experiment : A solid sphere of brass, resting on a glass stand, is covered by two accurately fitting hemi- spheres of brass. Putting these hemispheres in position on the globe, they are charged with electricity. On re- moving the hemispheres, they are found to contain the whole charge, whilst the globe itself presents no evidence of the presence of electricity, showing that the electricity only difluses itself on the surface. The form of the body receiving a charge greatly influences the distribution of the electricity. If a sphere be charged with positive elec- tricity, and then be made to approach another sphere not charged, the neutral electricity of the latter is decomposed, negative electricity accumulates on the side nearest the excited sphere, and positive on the other side (Fig. 4). If, instead of a sphere, a cylinder be charged, and brought so ELECTRO-PHYSICS. near an unexcited cylinder, the electricity accumulates at the extremities, and the phenomena of polarity are exhibited. Fk;. 4. - +irr^l- H Electrical induction. Certain substances without having the power to conduct electricity allow it to pass through them — in other words, Fig. 5. A plate-glass electrical machine. they are transparent to electricity, as glass is to light. Such substances are said to be dialectric. If electricity be excited on one side of a plate of glass, the other side will exhibit electrical phenomena. STATIC ELECTRICITY. 31 To obtain a large quantity of electricity, other means than friction of glass rods or sticks of resin become necessary. Two kinds of electrical machines are used — the cylinder and plate-glass (Fig. 5). The glass is sub- jected to friction by rubbers, and the electricity is collected by brass points and conveyed to a reservoir — the prime conductor (Fig, 6). The rubber becomes negatively and Fig. 6. A cylinder electrical machine. the glass positively electrified. In the Holtz machine (Fig. 7), the principle of induction is utilized. This machine consists of two circular upright glass or hard- rubber plates placed very near each other, without touch- ing, one arranged to revolve, whilst the other is fixed. The fixed plate has a central orifice, through which the axis of the other plate passes, and has on its outer surface some oblong pieces of parchment paper. In front of the revolving plate is a brass rod, containing at each extremity some projecting points or combs, and is fastened at the centre by a pivot. At the border of the fixed plate there are metallic combs, fastened on by rubber rods. There 32 ELECTRO-PHYSICS. are two condensers (Leyden jars), connected in their interior by brass rods, which communicate with the dis- charging rods ; and their exterior coating is connected by a brass rod passing under the wooden base. The fixed glass plate of the original Holtz machine had windows, through which paper points projected against the revolving plate. In the Toepler-Holtz, these windows are dispensed with, and soft wire brushes are so adjusted in front, as to rub against brass knobs fixed in the revolving plate. To Fig. 7. The Toepler-Holtz electrical machine. Start this machine, it is necessary, only, to place the dis- charging rods in apposition, and cause the revolving plate to move. When the current passes, the discharging rods are separated, and a stream of sparks flows from one to the other. For the purpose of storing up the electricity, a Leyden jar is employed — so named from the city where it was first made. This jar is coated with zinc-foil, both inside and outside, up to within one-fourth of its height (Fig. 8). STATIC ELECTRICITY. 33 As the Mass is a dialectric, whilst the interior receives positive electricity from the prime conductor, the exterior becomes charged with negative. By connecting a number of these jars, a battery is made in which a very large quantity of electricity may be stored up (Fig. 9), In forming a battery of Leyden jars, the exteriors of the jars communicate with each other and with the earth, whils.t the interior of each, also, communicates through the metallic rod and knob with each other, and with the prime Fig. 8. Fig. 9. A Leyden jar. A battery of Leyden jars. conductor of an electrical machine. The electricity received by a Leyden jar is condensed in contact with the tinfoil, and is in a state of hiorh tension. Discharoe is effected with a loud report, when the interior and exterior are brought into communication by means of a discharging rod — a curved brass rod terminating in knobs and pro- vided with insulated handles. A more or less vivid spark accompanies the discharge, made up of minute particles of brass and the air in an incandescent state. This discharge consists in the union of the positive ( + ) electricity within, and the negative ( — ) electricity on the outside of the jar. The addition of + and — in equal quantity produces zero in algebra, and an equilibrium in electricity. If the charge 34 ELECTRO-PHYSICS. of the jar — which is the quantity of electricity in it — exceeds its capacity, there will take place finally a spon- taneous combination of the plus and minus electricities. The intensity of electrification at any point of a body or surface is called the electric density at that point. Now,, the force with which electricity is moved to escape from any point or surface increases with the density. Difference of potential is said to exist whenever elec- tricity is about to move, or does move, from one point to another, and that place has higher poteiitial from which electricity moves, and that place lower potential to which electricity goes. The difference of potential between two points signifies the amount of work necessary to move a unit of electricity from one point to the other, against the direction it tends to go. If two conductors, having different potentials, be con- nected by another conductor, electricity will move from the higher to the lower potential until they are equak If the difference of potential is maintained by the ex- penditure of work, the fiow may continue so long as the work is done. As regards statical electricity, all parts of a conductor of the same material are always at the same potential, since when a difference of potential occurs the return to the same potential is effected in the minutest fraction of a second. CHAPTER III. DYNAMICAL ELECTRICITY. The original observation of Galvani, which led to the discovery of galvanism, may be readily repeated as fol- lows : A frog is rendered insensible by a blow on the head, and is then divided through the middle of the body DYNAMICAL ELECTRICITY. 35 with a pair of stout shears. As quickly as possible, the intestines are removed, the skin stripped off, and the lumbar nerves dissected out. The preparation thus made is laid on a glass plate, and under the nerves is placed a strip of zinc. Now, on touching the lumbar nerves and the zinc with a copper wire, brisk contractions of the thigh muscles immediately ensue. This demonstration was made by Galvani in i 790, and from it has proceeded the whole science of galvanism. As Volta was, next to Galvani, the most important of the early investigators, his name is also rightfully honored by denominating this force Voltaic electricity. The simplest mode of exhibiting the phenomena of galvanism is to plunge the dissimilar metals copper and zinc into diluted sulphuric acid. This constitutes a galvanic combination, or couplet, or element. When ordinary commercial zinc is put into the acid, chemical action at once begins ; the acid acts on the metal with great energy, and in a short time effects its solution. But the galvanic activity is by no means equal to the chemical. Owing to the impurities in commercial zinc, each strip immersed in the acid may be supposed to consist in a great number of minute galvanic combinations, between which complete circuits are formed. Hence, whilst the action is violent, no "current" proper is pro- duced. This serious objection to the use of commercial zinc in galvanic combinations has been entirely obviated by a fortunate discovery. It has been found that if ordinary commercial zinc is amalgamated, it is no longer acted on by the acid, except when the circuit is complete, and the secondary currents between the impurities in the metal and the particles of zinc are entirely prevented. The process of amalgamation consists in immersing the zinc in diluted sulphuric acid, and then rubbing the clean surface with some mercury. Immediately the zinc assumes a 36 ELECTRO-PHYSICS. silvery brightness, and its surface becomes homogene- ous. To develop a galvanic current, there must be dissimilar metals. Galvani supposed that the contact of dissimilar metals was alone necessary, but it was soon discovered that one of the metals must be acted on. That dis- similar metals are essential is undoubted, for if two plates of zinc, or two plates of copper are employed, there is no Fn;. lo. Galvanic couplets and conjunctive wire. result — no current is produced. One of the plates must be acted on, and becomes the generating plate, whilst the other is the condtic ting plate. To complete the circuit, the plates are brought into contact, or are connected by a wire of varying length, the conjunctive wire (Fig. lo). If the amalgamated zinc and the copper plate are placed in the exciting fluid — diluted sulphuric acid — and are not con- nected, no effect is observed, but as soon as the circuit is completed by bringing the metals into contact, or by attaching a conjunctive wire, a very decided disturbance is manifested ; bubbles of hydrogen gas arise from the decomposition of the water, sulphate of zinc is produced and dissolves in the diluted acid, and a galvanic current passes. When the circuit is broken at any point, action at once ceases. During the passage of the current, the conjunctive wire acquires new properties, and is changed from its ordinary DYNAMICAL ELECTRICITY. 37 Fig. II. condition. Its temperature rises, and, if a magnetic needle is brought into its neighborhood, the needle is deflected (Fig. ii). It is found, further, that the de- flection of the needle follows a definite law. If the conjunctive wire be placed in the magnetic meridian, the zinc end toward the north, and the needle is then put above the wire, the marked end (north) will deviate eastward ; if put below the wire, it will de- viate westward. Obviously, the direction which the needle takes is determined by the course of the current. Not only is the direction of the current indicated by the needle, but the strength of the current may, also, within certain limits, be measured by the extent of the deviation. The magnetic needle thus becomes a galvanometer. To render its indications more certain and precise, some modification of the needle becomes necessary. By em- ploying two needles of the same strength, suspended one above the other, and having their poles opposed, the directive force of the earth's magnetism is overcome, and Aciion of the current in the con- junctive wire on the needle. Fig. 12. Fig. 13. Fig. 14. Simple galvanometer. Astatic (J Ivanometer. Another form of the same. the combination hence is exceeding susceptible to galvanic influence. Such a combination is known as astatic (Fig. 13). If around the needle there are many turns of fine 38 ELECTRO-PHYSICS. wire, carefully insulated, and arranged for communication with the terminals of the battery, the whole constitutes a galvanometer of much delicacy (Fig. 14). It has already been demonstrated that, for the production of a galvanic current, two things are essential — chemical action, and on one of two dissimilar metals. The current originates at the point where the chemical action is taking place ; hence, in the combination of zinc and copper, the zinc plate is the generating plate. From this, then, the current sets out (Fig. 10). The direction of the current is in the liquid from the generating plate to the conducting plate — from the zinc to the copper. That the current shall pass from one plate to the other, it is necessary that the intervening molecules of fluid shall be polarized. At the surface, where the chemical action is going on, the galvan- ism is positive and consequently the adjacent molecule is, on the side nearest the plate, electrified negatively. As each molecule is in turn thus aflected, it is obvious that the conducting plate will be finally reached, and that it will be electrified negatively. When two zinc plates, instead of a zinc and a copper plate, are inserted in the exciting fluid, this polarization of the molecules cannot take place, for the action, beginning at the surface of each plate, one just counterbalances the other, and no current passes. From the conducting plate the current passes to the conjunctive wire, thence to the generating plate, thus completing the circuit. Whilst within the battery, the current passes from the zinc to the copper element; outside, it passes from the copper to the zinc, so that, although the surface of the zinc is positive, the copper element outside becomes the posi- tive pole, and the zinc the negative pole. Electro-motive force is a term used to denote the sum of all the differences of potential effective on a galvanic circuit. In a simple cell the electro-motive force is the DYNAMICAL ELECTRICITY' 89 difference of potential between the two elements compos- ing it ; in the compound circuit it is the result of the com- bined differences of potential. Current strength is the quantity of electricity transmitted along a conductor per second, the unit of time. Current of quantity is one having a large volume of electricity; current of tension is one having power to over-, come resistance. The resistance to the passage of a cur- rent is proportional to the length and sectional area of the conductors. The current from a single large element, immersed in bichromate solution, will redden, even volatil- ize, platinum wire ; whilst the current from twenty medical battery elements, united in series, will barely warm the wire. In the latter case the electro-motive force is dimin- ished by the resistance encountered in each element and in the conductors between them. It follows, therefore, that the intensity is dii^ectly proportional to the electro-motive force, and inversely proportional to the resistance encountered zvithin the cell or element^ and on the circuit. R + r I represents intensity, which is equal to E, the electro- motive force, divided by R internal, and r external resist- ance. Internal resistance is due to the liquid and to the conducting element, and external resistance to the con- ducting wires. Applying the law above given, the internal resistance is the greater the further apart the elements are, and the o[-reater the lenorth of the wire connecting- them in series. The unit of electro-motive force is the Volt, diminutive of Volta. To give this concrete expression, it may be stated that the volt very nearly represents the electro- motive force (power) of one element of Daniell, which becomes, therefore, the standard of comparison, to which 40 ELECTRO-PHYSICS. the strength of all other battery elements is referred. The Leclanche element has an electro-motive force of 1.5 volts, and the Bunsen of 1.8 volts. The unit of resistance is designated the Ohm, the name of the discoverer of the celebrated law. The standard of the unit of resistance is a piece of telegraph wire one hundred metres in length and of a certain defined sectional area. A current of electricity passing through such a piece of wire would encounter a resistance which is taken as the unit, or the ohm. As in electric lighting and heating, etc., the performance of a given battery is in part determined by the number of ohms resistance, a standard by which it can be judged is, of course, highly necessary. The unit of intensity is the Ampere,^ the name of a dis- tinguished electro-physicist. To give this concrete ex- pression, it may be stated that an ampere represents the quantity of electricity generated by the unit of electro- motive force — the volt, circulating in a conductor having the unit of resistance, the ohm, during the unit of time. It has been ascertained practically that this is the quantity of electricity furnished by an element of Daniell, traversing one hundred metres of certain telegraph wire in the time of a second. The unit of capacity is the Farad, a contraction of Faraday. One farad is equivalent to one million of micro- farads. The farad is the capacity of a condenser which holds one ampere at a potential of one volt. A condenser of one microfarad capacity contains about three hundred circular sheets of tinfoil separated by mica plates, and would be held by a box three and one-quarter inches deep and six and a half inches in diameter,^ ^ As no distinguished Frenchman has been represented in this nomenclature, it was proposed at a recent meeting of the International Scientific Congress to substitute the name of Ampere for Weber, which was formerly used, and hence now the unit of intensity is the Ampere. 2 Gordon, Treatise on Electricity and Magnetism. New York, 1880, vol. i. p. 243. DYNAMICAL ELECTRICITY. 41 The forms of elements adapted to medical purposes, and their arrangement in combinations, will be considered most conveniently after an examination of the various kinds now in use in the next chapter. Measurement of Current Strength. — The ordinary gal- vanometer affords no exact measure of the strength of the current, only its direction. It is very desirable to be able to express in volts the strength of a given current, and in ohms the amount of resistance. The ordinary galvano- meter, or rather galvanoscope, may be converted into an instrument giving the current strength in absolute units, by having the scale graduated in milliamperes, and the movements of the needle compared with that of an abso- lute ofalvanometer. Galvanometers measuring in absolute units, are now to be obtained at a reasonable price. The number of cells used does not afford positive information of the current strength, for the electro- motive force and the resistances on the '°' ^^' circuit vary greatly from time to time. With a proper galvanometer, the num- ber in milliamperes of the current's strength is at once known. Another instrument for determining the current strenorth is the voltameter O (Fig. 15). This consists of an apparatus for effecting the decomposition of water by the current, and for collecting its products — oxygen and hydrogen. It is known that the amount of chemical work done by the galvanic current is in proportion to its strength. The quan- tity of oxygen and hydrogen, therefore. Voltameter. collected in a griven time, indicates the strenorth of the current. It is found that the unit current of one ampere, which is one volt working through one 42 ELECTRO-PHYSICS. ohm of resistance, separates about 0.115 cubic centimetre of hydrogen in a second, or 6.9 c. c. in a minute. If the tubes receiving the gases are properly graduated, the strength of the current is known from the quantity of the eas obtained. Althoup^h not a convenient method of determining current strength for ordinary purposes, it is employed by Ciniselli for ascertaining the strength of cur- rent necessary for coagulating the blood in an aneurismal sac. Current strength may be roughly tested by touching the tongue, lips, cheeks, or hand of the operator. Measiu^ement of Resistances. — Rheostat is the term used to designate the instrument by which resistances are interposed in the circuit, and may be liquid, or composed of coils of wire. The liquid used is water, or preferably a saturated solution of sulphate of copper. This is con- tained in a glass tube, closed with brass caps, and having a movable rod, which is so arranged that any desired stratum of liquid can be interposed between the terminals of brass. Accordino; to the thickness of the stratum is the resistance, which having been compared with the scale of standard resistance coils, a special scale can be con- structed for the rheostat. A liquid rheostat furnishes approximative results, only. The most accurate instru- ment for measuring resistances is the wire rheostat, or resistance coils. These are coils of German silver wire, of certain definite length and sectional area. The law of resistance of a wire to the passage of a galvanic current is — directly as its length, and inversely as its sectional area. The unit of resistance — the ohm — means the resist- ance offered to one volt by a wire 200 metres in length. It follows that coils of wire, having a resistance of 5, 10, 50, 500 ohms, may be so arranged as to be interpolated in the circuit. Beside the advantage of having a means of determining the resistance of the body and in the DYNAMICAL ELECTRICITY. 48 battery Itself, the applications of any current strength are greatly improved in smoothness and exactness by the use of resistances. Processes of Galvanic Discharge. Although apparently a continuous flow, the galvanic current moves by successive discharges, too rapid to be recognized. The processes of galvanic discharge, by conduction, by disr2{ptio7i, and by convection, employed In the various practical arts, are also utilized in medical practice. Discharge by CondiLction. — When the two poles of a galvanic battery are brought into different potentials, and are united by a conducting bridge, an equalization of the potential takes place through the bridge, by the flow of electricity from the higher to the lower potential. As has been shown, the conducting bridge or wire — the conjunc- tive wire — acquires some new properties by the passage of the current; amongst others. Its temperature rises. The conductivity of the different metals for electricity varies nearly as for heat. The electric conductivity of metals has been carefully determined, and is found to be as follows : If silver, which is the best conductor, is taken as the stand- ard, or at I GO, copper will be about 77, gold about 60, zinc 30, iron 14, and platinum about 10. The conductivity is much affected by Impurities, and the above numbers are based on the examination of pure metals. Copper is especially affected In this way, its conducting power being reduced from 50 to 90 per- cent, by certain Impurities. In- crease in the temperature of a conducting wire lessens Its conductivity, also. When a current of electricity, which will readily traverse a pure copper wire of a certain sectional area. Is made to pass through a finer platinum wire, greatly increased re- 44 ELECTRO-PHYSICS. sistance is thus encountered by the current, and the tem- perature of the platinum rises to a red, to a white heat, or possibly to a temperature at which the metal volatilizes. In the arrangement of a battery for heating effects, it is necessary to diminish the resistance at all points, so that, as far as possible, the current produced can be utilized in heating the wire. These principles are applied in the con- struction of batteries for caustic effects, and for lighting by incandescence. A platinum wire heated by the current may be used in the form of loop for the removal of pe- dunculated growths ; or a platinum wire or a thin piece of carbon may be rendered incandescent for the purpose of illuminating cavities, etc. These applications of galvanic discharge by conduction will be fully considered hereafter. Discharge by Disrupiion. — \n the process of galvanic discharge by disruption, a current of high intensity leaps over the distance between the conductors. The brilliant light thus produced is not the electrical current itself, as might be supposed — for electricity is invisible — but is pro- duced by the incandescence of particles thrown off from the terminal. The terminal points usually consist of car- bon, and an excavation occurs in the positive carbon, and a deposit is continually made on the extremity of the nega- tive carbon. As the consumption of the points goes on a greater separation of them takes place, and finally the cur- rent is unable to leap over the interval. Mechanical con- trivances, hence, become necessary to maintain the carbon points at a constant interval. In the various methods of electric lighting by disruptive discharge, the main diffi- culties in this direction are overcome by special mechanical means. Discharge by Convection — Electrolysis. — As interesting as may be the other modes of galvanic discharge, the method by convection is the most important. There are certain terms employed in this connection which require explana- FORMS OF GALVANIC COMBINATIONS. 45 tion. The process of electrical separation of the elements of a compound is called electrolysis (from "electricity" and Ztwf, releasing). A substance which can be so decomposed is designated an elech^olyte. The poles of the battery are called electrodes {b6hQ, a way), meaning the way the current enters or leaves the electrolyte, or compound, or body, on which it acts. There are certain laws of electrolysis. An element can- not be further decomposed. Decomposition or electrolysis occurs only when the particles of the body are in a movable state — that is, in solution. During the process of electro- lytic decomposition the disengaged substances pass to the poles. Those are termed afiions which go to the anode or positive pole, and those cations which go to the cathode or negative pole. As unlike electricities attract, it follows that the anions are electro-negative, and the cations elec- tro-positive substances. Oxygen, chlorine, and the acids appear at the positive electrode ; and hydrogen, the alka- lies, and the metals appear at the negative, the former being electro-negative and the latter electro-positive substances. The manner in which electrolysis affects the constituents of the body will be discussed hereafter, when the subject of the surgical applications of electrolysis will come up for consideration. CHAPTER IV. FORMS OF GALVANIC COMBINATIONS. The simplest form of a galvanic battery is that to which reference has been so frequently made — a cup containing a zinc generating plate, a copper conducting plate, and an acidulated fluid electrolyte (Fig. i6). Whilst the zinc plate is acted on and dissolved, the electrolyte itself is decom- 46 ELECTRO-PHYSICS. posed into its elements, hydrogen appearing at the nega- tive pole. In the more complete batteries, two fluids are employed, the object being to prevent polarization of hydrogen and of other products of the electrolytic decom- FiG. i6. Single fluid, zinc and copper elements — trough battery. position, Single fluid batteries are more readily portable, and are, therefore, much used notwithstanding their obvi- ous deficiencies. One of the best known sinole fluid combinations is that of Smee (Fig. 17). The elements consist of zinc and pla- Smee combination. A. Exciting fluid. S. Silver plate, platinized. Z. Zincs. tinum, which are so widely separated, in respect to their position in the series of electro-positive and electro-nega- FORMS OF GALVANIC COMBINATIONS. 47 tive bodies, that they are well fitted for combination. It has been found that a silver plate, coated with platinum black, is quite as effective in the combination as platinum itself, and is much less expensive. In this battery the ex- citing fluid is diluted sulphuric acid, and the chemical action consists in the decomposition of water, hydrogen appearing at the platinum, which is the electro-negative element within the battery, and in the formation of the sulphate of zinc, which is dissolved in the diluted acid. In this com- bination, the action is prompt, and the force of the current Fig. 1 8. Fic. 19. Grenet cell. Another form of Grenet's cell. soon rises to the maximum ; but, unfortunately, it is not constant, for whilst the maximum is quickly attained, the strength soon drops, and presently falls to zero. This ex- treme fluctuation in the streng-th of the current is due to the rapid chemical action, to the formation of sulphate of zinc, which stops the action on the zinc, and to the accu- mulation of hydrogen on the platinized silver. The great fluctuations in the strength of the current from the Smee battery, and the care necessary to keep it in order are serious objections to its use for medical purposes. 48 ELECTRO-PHYSICS, Probably the best form of single fluid battery is the cell of Grenet (Fig. i8). Zinc and carbon are the elements, and the exciting fluid is an acid solution of bichromate of potassium. The chemical action is similar to that of the Smee, but in this the hydrogen is appropriated so that it FORMS OF GALVANIC COMBINATIONS. 49 does not accumulate on the carbon plate. The Grenet cell, further, has an arrangement for lifting- the zinc out of the fluid when not in use (Fig. 19). Although more constant than the Smee, there are the same objections to it as to a constant battery: the current rapidly attains the maximum, and then falls to zero. In the Stohrer battery, the same form of elements and the same exciting fluid are employed. The Stohrer constant battery has an arrangement by which the elements can be raised out of, or lowered into, the fluid. For the portable battery, Stohrer's cell (Fig. 20) is proba- bly more frequently employed at present than any other ; but several new combinations, such as the Partz (Fig. 21) Fig. 21. Partz Electric Battery Co., Phila. Portable voltaic battery. and the " chloride," are beinor introduced with much sue- cess. The chloride battery seems to be peculiarly well adapted to medical work, but the composition of the ex- citing fluid remains a secret. But it is known that it con- tains corrosive chloride of mercury, which, in the course of the reactions that ensue, is reduced to metallic mercury. This battery is provided with a special rheostat so that all of the cups can be simultaneously used, the number of milliamperes being accurately ascertained by an absolute galvanometer. 50 ELECTRO- PHYSICS. A battery, to be constant, must contain two fluids. In those of two fluids the polarization of the hydrogen and of other products of electrolytic decomposition is sought to be prevented by certain chemical reactions and by me- chanical means. One of the most powerful of these is Grove's "nitric acid battery" — the elements of zinc and platinum. The zinc element is acted on by diluted sul- phuric acid, and the conducting element — the platinum — is suspended in nitric acid contained in a porous cup (Fig. 22). By this arrangement, polarization of the hydrogen is Fig 22. Fig. 23. Grove's element. Grove's battery. prevented by its entering into combination with a portion of the oxygen of the nitric acid, reducing it to hyponitrous, the fumes of which are given off when the battery is in action. The porous cup acts mechanically as a diaphragm to prevent the deposit of zinc on the platinum, which, in this arrangement, is kept clean and bright, and therefore in the best condition to conduct the current (Fig. 22). In the combination known as the Bunsen, the arrangement of the elements is the same as in the Grove, except that the negative plate is carbon instead of platinum. The price of such a combination is much less than that of the Grove, but the carbon does not long retain its properties, and must be FORMS OF GALVANIC COMBINATIONS. 61 frequently well washed and baked over,^ When the carbons are fresh, the action of this battery is very powerful, some- what more powerful than the Grove, but it is not as con- stant as the latter. Owing to the fumes given off by them, and the expense and trouble of their manipulation, these two forms of constant battery of two fluids are not adapted to medical uses. Probably the best of the two fluid bat- teries, as it was first invented, is Daniell's. The elements are of zinc and copper, separated by a porcelain or baked- clay diaphragm. The zinc is immersed in diluted sulphuric acid, and the copper in saturated solution of sulphate of copper. Sulphate of zinc is formed, the sulphate of copper is decomposed, the copper is deposited on the copper, and the sulphuric acid diffuses through and reinforces the acid attacking the zinc. The hydrogen is here utilized in the decomposition of the sulphate of copper solution. To render the action constant, crystals of sulphate of copper are kept in a basket suspended in the copper solution, thus maintaining the solution at the point of saturation. The Daniell combination is of especial medical interest, because, as modified by Siemens and Halske, under the direction of the celebrated Remak, it has been, and con- tinues to be, the favorite combination for medical purposes on the continent of Europe and with many in this country. In the modified Daniell cup, the copper element is in the form of a rosette, and is surrounded by a saturated solu- tion of the sulphate of copper, which is maintained at the point of saturation by a number of crystals. Over the copper element is placed a cup-shaped, inverted porous diaphragm, and around this is packed a quantity of paper pulp, or soft papier-mache, which supports the zinc element. 1 The carbon for battery purposes is gas carbon. It is mixed with treacle, put into suitable moulds, and baked in an oven. When its properties are im- paired, they may be almost entirely restored by washing the carbon thoroughly and subjecting it again to the heat of the oven. 52 ELECTRO-PHYSICS. Around the zinc and covering it is water only. The sul- phate of copper is decomposed, copper is dejDOsited on the copper rosette, and the sulphuric acid diffuses through to attack the zinc (Fig. 24). This form of battery requires but little attention. Water is needed every few days to supply the loss by evaporation, and some crystals of cop- per sulphate must be dropped into the copper solution occasionally. The action of this battery is remarkably constant, and it will continue so for months, requiring no further attention than addinof a little water. The action on the zinc is slight, and the resistance within the battery about equal to that of the body — hence the smoothness of KiG. 24. i \_A::t3,z?iiB^/U-^ Siemens and Halske"s modification of tlie Daniell element, as made for Remak. Transverse section. the current. After the first expense of construction, there is but little required to keep it in good working order. For the purpose of a permanent battery it is, in the author's experience, the best. After many trials and failures, I have finally adopted this form for office use in my private prac- tice. 1 he cup should have a capacity not less than two quarts, and the zincs should be about three inches in height, an inch in thickness, and twelve inches in circumference, less a space of two inches, so that they can be removed without disturbing the connections of the copper element. Another modification of the Daniell cup, now much em- ployed for telegraphy, is "Hill's gravity battery" (Fig. 25). I FORMS OF GALVANIC COMBINATIONS. 63 In this arrangement the copper element consists of a large copper plate which rests on the bottom of the cup, and the zinc element, also a broad disk having a large orifice in the centre, is suspended by a hanger from the side of the cup, reaching down about midway. The copper element is sur- rounded by a saturated solution of sulphate of copper, and the zinc element by a solution of sulphate of zinc. They are kept apart by the difference in specific gravity. The copper solution is kept saturated by dropping crystals of the sulphate through the fluid, and through the opening in the zinc element. The cells must not be agitated, lest diffusion take place, and the surface of the zinc solution should be Fig. 2;. Hill's gravity element. covered with a layer of paraffin to prevent evaporation. This form of cup is found to answer very well for medical purposes, and is especially praised by Hammond. An- other modification of the Daniell made by Trouve, consists of disks of copper and zinc, the former covered by paper pulp, moistened with a saturated solution of sulphate of copper, and the latter covered with paper, moistened with sulphate of zinc solution. Trouve has also improved the gravitation battery. Forty elements of either form suffice for most purposes. The chloride of silver battery is also a very efficient 64 ELECTRO-PHYSICS. combination. As made by Gaiffe, of Paris, it is very much praised by De Watteville. The cells are less than three inches in length and one inch in diameter, and are com- posed of zinc and silver rods in a vulcanite cup. The ele- ments are separated by a fold of bibulous paper, moistened with chloride of zinc solution (three per cent.), and at the bottom of the cup is placed some chloride of silver. The electro-motive force of this cell is about 1.5 volts. Another convenient combination is the sulphate of mercury element, composed of zinc and carbon rods, placed in a test-tube and separated by saw-dust, moistened with acidulated water, and having a thick layer of sulphate of mercury at the bottom. These elements are put in a box, the top of which is a pole-board containing selectors, galvanoscope, rheophores, etc. The element of Leclanche, which is patented, is largely used in this country by the district and house telegraph, burglar-alarm, etc. It is much praised by some French electricians, and by Poore, who regards it superior to all other forms of galvanic combination. As it is patented, it can be repaired only by the agents of the owners. The elements are composed of zinc and gas carbon, the latter placed in a porous cell and surrounded with native per- oxide of manganese, mixed with coarsely powdered carbon. The porous cell with its contents is placed in a glass vessel of quadrangular shape containing a saturated solution of ammonium chloride (sal ammoniac) and a rod of zinc. Ammonia is set free and absorbed by the water, chloride of zinc is formed, and hydrogen is set free, but its polariza- tion is prevented by combination with the oxygen of the peroxide of manganese. As the cup is carefully sealed, escape of its contents cannot take place, and hence this combination is very useful for portable batteries, since the cups can be obtained from two ounces upward (Fig. 26). The late developments in the industrial applications of FORMS OF GALVANIC COMBINATIONS. 55 electricity have led to the invention of numerous forms of galvanic batteries for medical purposes. One of these, figured below (Fig. 27), the Partz "Acid gravity Fig. 26. battery." has, it is stated, an electro - motive force of 1.95 volts. The elements are inclosed; the current selector is arranged to slide along a bar, and any desired combination Fig. 2', Partz Electric Battery Co.. Phila. Cautery battery. of cells can be made at once, so that the manipulation is easy. The special point in the construction of this battery is the use of "a sulpho-chromic salt." The exciting fluid 56 ELECTRO-PHYSICS. consists of an alkaline chloride, preferably that of ammo- nium (i part in 5 parts of water). To this is added 5 to 10 per cent, of hydrochloric acid. "The depolarization is effected by means of a ' sulpho-chromic salt,' made and furnished by this [The Partz] Company." Another American battery recently brought forward, is known as the " chloride battery," in which the reduction of mercuric chloride furnishes the chemical action necessary. This appears to be a most successful arrangement. It is proposed by the inventor to use the whole battery at once, how many amperes soever may be desired, the strength of the application being regulated by a peculiar rheostat. This we are certain, is a happy conception. How MUST Cells be Arranged ? In the construction of batteries for medical purposes the arrangement of the cells is determined by the purpose for which the battery is to be used. For the same metal and the same acid solution the electro-motive force is the same, whatever may be the surface of the metal immersed, and the volume of the liquid. Whilst the current from a single large cell in bichromate of potash solution will redden, even volatilize, a platinum wire, twenty elements of the size usual for medical batteries will barely warm the same wire. In the latter there are twenty times more electro- motive force and twenty times more tension ; but the energy is diminished by the resistance in each element, and hence the quantity of electricity available for use is much less than in the sino-le laree element. When the cells are united, zinc to zinc, and copper to copper, the combination is a "simple circuit;" and when the zinc of one cell is united to the copper of the next, and so on throuorhout the whole number, the combination is said to be a " compound circuit," or " in series." If we FORMS OF GALVANIC COMBINATIONS. 57 take the Daniell element for illustration, the problem is simplified. The Daniell has an electro-motive force of one volt, and if joined in series thirty will have the force of thirty volts, but if joined in simple circuit, will have an Fig. 28. Portable battery of thirty elements, the movable top provided with current selector, reverser, and galvanoscope, as made by Flemming, of Philadelphia. electro-motive force of only one volt, but will constitute a large plate thirty times the size of one plate. If the reader will now recall that intensity is the power to overcome resistance, and that 1 = R + r and that the resistance of the human body is thousands of ohms, he will at once comprehend that a battery for medi- cal applications must be arranged in series. The best re- sults are attained when the interior resistance of the battery 58 ELECTRO-PHYSICS. is equal to the resistance on the exterior circuit. Applying this principle, what will be the arrangement when the bat- tery is to coagulate the blood of an aneurismal sac, the resistance of which is about eight ohms ? As the external resistance is so small, the internal must correspond. As the internal resistance of the element of Daniell is twenty or more ohms, this is not suited to this particular purpose. The zinc carbon combination of Stohrer or Grenet, ar- ranged in simple circuit in pairs, of which four will furnish the necessary electro-motive force, is appropriate. A combination of elements for heating a platinum wire, which has a resistance of one-half ohm, must have, consequently, a minimum of resistance. Large plates united in simple circuit, and as closely placed as possible, are required; and on this principle caustic batteries are now made. The guiding principle in the selection of the element for forming a battery for medical purposes, is that the interior resistance of the battery element shall equal the resistance of the human body. It is this, amongst other reasons, which renders the element of Daniell, as modified by Siemens and Halske for Remak, so useful and desirable for medical practice. The internal resistance is so increased by the papier-mach^ packing and the porcelain diaphragm, that it equals the resistance offered by any part of the body. Hence it is said to be smooth and unirritating when the same number of elements of Stohrer give rise to great irritation and burning. In this fact we find the true ex- planation of the superiority in curative action of the large' elements in a permanent battery, as compared with the small elements of a portable battery. Boudet,^ recognizing the importance of this principle, advises that materials hav- ing imperfect conducting power be interposed between the surface of the zinc and the conducting element to increase the internal resistance. Such elements are remarkable for ^ Revue de Medecine, Sept. lo to Oct. lo, 1881. FORMS OF GALVANIC COMBINATIONS. 59 their constancy and uniformity. The Siemens and Halske element will remain in use, furnishing a current of uniform intensity for a year at a time, requiring- only some crystals of blue vitriol and sufficient water to cover the zincs occa- sionally. It may even be short circuited for days without impairing its strength, whereas a Leclanche or a Partz would run down in a few hours under these circumstances. Galvanic batteries are portable or permanent. The portable consist of small elements (Smee, Grenet, Stohrer, etc.) and a single fluid, and are so arranged that the ele- ments can be lowered into or raised out of the excitinof fluid when not in use (see Fig. i8). The permanent batteries are composed of large cells with two fluids, and are fixed in some convenient position. Whether movable or not, a battery of many elements requires mechanical contrivances for working it. The portable batteries are fitted with a movable "selector," which is so arranged that various num- bers of cups can be interpolated in the circuit. Permanent batteries are arranged in combinations, and are worked by a pole-board on which are placed brass knobs communicat- ing with the various sets or combinations of cups (Fig. 29). Fig. 2q. O; O !ft. 'rt:-®^ i|-:'0 #:# IVII. Flemming's key-board. These sets are on one side usually from one to ten, and on the other from ten to fifty, sixty, ninety, or any other num- 60 ELECTRO-PHYSICS. ber of cups of which the battery may be composed. By means of a selector any possible number of cups from one up to the limit of the battery may be selected for the desired application. The pole-board should also contain a "polarity changer," an arrangement for quickly changing the poles, a " commutator," and an "interrupter" (rheotome), which may run either by clock-work or by an electro-magnet, for interrupting the current slowly or quickly as may be neces- sary. Besides these, pole-boards are usually supplied with a galvanometer, a rheostat, or resistance coils. The ordi- nary galvanometer, which, theoretically, measures the force of the current, does not actually afford constant and relia- ble indications, and can be depended on only to indicate the direction of the current. The cheek and tongue of the operator become in actual practice a delicate and trust- worthy galvanometer ; but now no pole-board can be con- sidered properly equipped which does not contain a gal- vanometer (a milliamperemfter) graduated in absolute units. Fig Resistance coils. Most pole-boards are supplied with a water rheostat by which different degrees of resistance are brought within the circuit, but for any nice determination resistance coils are necessary. As the resistance offered by a wire depends on its length and the area of its section, it is obvious that, FORMS OF GALVANIC COMBINATIONS. 61 by having coils of certain standards of length and thick- ness, a fixed and definite amount of resistance can be in- troduced into the circuit. Such are the resistance coils now used to be interpolated in the circuit, for inducing definite resistances in ohms (Fig. 30). The Simens' unit of resistance consists of mercury having the temperature of 0° C, contained in a elass tube one metre lono- and one Fig. The Flemming cabinet battery. This cabinet battery is arranged with movable boxes which contain the cups of elements, and the pole-board having a current selector, a gal- vanometer, a water rheostat, an induction coil, etc. This is intended for office use only, and is an elegant piece of furniture as well as a convenient battery. 62 ELECTRO-PHYSICS. square millimetre in section. As this is an arbitrary stand- ard, it cannot be connected with any absolute system of Remak's battery. This diagram is intended to illustrate the original arrangement of galvanic battery and key- or pole-board adopted by Remak. The battery is composed of 60 elements of Daniell, as modified by Siemens and Halske, connected with an up- right key-board which is supposed to stand as an office table. The cups are arranged in two sets: On the left-hand side 10, commencing at o, which is attached to the central plate on the key-board, and on the right 50, arranged in combinations of 5. The key- board contains a galvanometer, G, which can be cut off at. a; current selectors, B ; a polarity changer, W N, which is interposed so as to affect the current passing from the cups to the electrodes, K Z. The battery, B, can be put into the cellar, a closet, or cabinet, and the key-board may stand on a table iti the consultation-room. The key- boards now made by the American dealers are much superior to this, which is chiefly interesting on account of the association with Remak. FORMS OF GALVANIC COMBINATIONS. 63 measurement, That which is now employed chiefly is known as the B. A. unit, because introduced by the British Association. It is also called the Ohm. It is based on the principle that the resistance of a uniform wire of given material is proportional to its length, divided by its weight. In the resistance coils, the resistance is known in absolute measure, and to them all other wires are referred. The B. A. standard, or unit coil, is a wire composed of an alloy of 66 per cent, of silver and 33 per cent, of platinum, which was finally selected by the committee of the Association as superior to all others. The pole-board may be placed in the office, consultation- room, or ward of a hospital, and the battery elements at a distance — in the cellar usually. They communicate by means of insulated telegraph wire — wire coated with gutta- percha (Fig. 32). The portable battery, on the other hand, may be carried to any point — to the bedside of the patient, if necessary. On first view it might appear that the port- able battery is more convenient and useful than a perma- nent arrangement. When we come to investigate further, we find that portable batteries require much care, and need to be frequently cleaned and recharged to preserve their activity. They furnish a current of relatively high tension and small volume, which is not capable of effecting the same therapeutical results as a battery containing larger elements. Furthermore, no portable battery of a single fluid furnishes a truly constant current, for, although a ealvanic current, the variations in tension are sudden and considerable. When the battery is freshly charged, the current rises immediately to the maximum, but soon de- clines to a greater or less extent. Of course, this variation of tension only occurs with a single fluid battery. If the portable battery were composed of elements arranged to obviate these defects, it would have all the advantages of a permanent battery. 64 ELECTRO-PHYSICS. CHAPTER V. ELECTRO-MAGNETISM. When the galvanic current is passing through the con- junctive wire of the battery, the wire becomes a magnet, and will attract iron-filings ; but when the current ceases, the magnetic property does also. When the conjunctive wire thus becomes a temporary magnet, if a magnetic needle is brought near, it assumes a position at right angles to the direction of the current in the wire (Fig. 33), Just ¥u;. Needle surrounded by a coil of insulated wire. When the current is made to traverse the coil, the needle is deflected. Represented at re^t. Fio. 34. A bar of iron wrapped with insulated wire. When the cur- rent passes the soft iron is ren- dered magnetic, and the cross- bar with the weight is firmly attached. as a permanent magnet may induce the magnetic property in a piece of iron, so the conjunctive wire — temporarily a magnet — can induce the magnetic property in a bar of iron (Fig. 34). Thus, take a bar of iron in the horseshoe shape, and coil around it an insulated wire, which communicates ELECTRO-MAGNETISM. 65 with, and is an extension of, the conjunctive wire ; it will be found, as soon as the current traverses the wire, that the iron has acquired strong magnetic property, and pow- erfully attracts another piece of soft iron — the anchor or armature — so strongly that considerable force is necessary to separate them. When the circuit is open, the horseshoe ceases to be a magnet, and the anchor at once falls away. Such a temporary magnet is an electro-magnet, because the magnetism exists in it only when the electricity is passing. It was the Danish philosopher. Oersted, who, in 1819, discovered the influence of the conjunctive wire on the magnetic needle. The next step in the progress of dis- covery was the demonstration by Arago, in 1829, that the electric current can induce magnetism in iron and other bodies. It remained for Faraday to complete the discover- ies by showing that a galvanic current can induce electrical currents in conducting wires. If the conjunctive wire of the battery, coiled on itself and properly insulated, is laid on an insulated surface, and in its immediate neighborhood is placed another coil of insulated wire, connected with a galvano-multiplier, it is found that when a current is passed through the former, the needle of the multiplier is on the instant deflected, then it oscillates a little, and presently comes to rest. If, now, the circuit is opened, the needle is again deflected, but this time in the opposite direction (Fig. 35). Instantaneous currents are, therefore, induced in one wire by a galvanic current passing in another wire near. The wire connected with the battery transmits an inducing current; the secondary wire transmits an induced current; but the latter is instantaneous, and exists only at the opening and closing of the circuit. The needle of the galvano-mul- tiplier, or galvanometer, not only shows that instantaneous currents are induced, but also indicates their contrary di- rection. The induced current, starting on the breaking of the circuit, is more powerful than that starting on making 66 ELECTRO-PHYSICS. of the circuit. On closing the circuit, the direction of the induced current is opposite to that of the inducinor ; on opening or brealcing the circuit, the induced current is in Fig. 3^. The smaller coil — the primary coil — is connected with the batteiy. When the primary coil, which is connected with the battery, is lowered into the secondary, a current at once starts in the latter, as shown by the movements of the needle. A current starts in the other direction when the primary coil is withdrawn. The galvano-muliiplier con- nected with the secondary coil is not shown. the same direction as the inducing current. It is, there- fore, a to-and-fro current, instantaneous, and not, hke the galvanic current inducing it, a continuous current passing in one direction. It was soon ascertained that much more powerful instan- taneous currents are produced if two wires of very great length, carefully insulated, are rolled into coils, and placed near to each other. The wire of the inducing coil is, how- ever, always shorter and thicker than that of the induced. In this way the surface for inductive action is enormously increased (Fig. ;^6). In the Ruhmkorff coil, which, if of large size, will furnish sparks an inch or more long, there are hundreds of yards of very fine wire in the induced coil. It was further ascertained that the intensity of the indue- ELECTRO- MAGNETISM, 67 tion current derived from the coil is greatly increased by introducing some pieces of soft iron in the cavity of the coil or bobbin. When the current passes, the soft iron becomes magnetic, just as the horseshoe bar does when the current traverses the wire wrapped around it. The magnetized Fig. 36. illjiH|^^Hg^ Ruhmkorff's coil. soft iron, in turn, acts on the wires about it, and hence exalts the action in them, or increases the strength of the current. The soft iron induces instantaneous currents in the coil at the moment of acquiring and of losing its own magnetism. This effect is still heightened if the soft iron put into the core of the bobbin is composed, not of a single piece, but of a bundle of wires or needles, each one of which is insulated from the rest by a layer of varnish. The important contributions of Faraday to our knowl- edge of these facts, have coupled his name to this form of electro-magnetism, which is hence known as Faradism or Faradic electricity. The successive steps in the progress of discovery have been stated, to render clear the construc- tion of the apparatus by which the force — electro-magne- tism — is utilized in medical practice. The electro-magnetic or faradic battery consists of the galvanic couplet, or of two ; of the inducing coil, which is an extension of the conjunctive wire of the cup ; of a rheo- tome or current interrupter; of a secondary coil, in the 68 ELECTRO- PHYSICS. same bobbin with the primary coil ; a bundle of soft iron wire in the core of the bobbin ; polarity changer ; elec- trodes, etc. Fig. 37. Ko. 1. No. 3. The Grenet cell. No. 4. The couplet (Figs. 37, 38) now most frequently used, and the best for this purpose, probably, is the Grenet, which is composed of zinc and carbon elements, and has Fig. 3S. The Flemming battery cell ELECTRO-MAGNETISM. 69 an arraneement for liftinor the zinc out of the fluid. The Smee combination is also a good deal used, but platinized silver is substituted for platinum. It is rare, indeed, that more than one cup is required in the ordinary applications of a faradic battery ; hence, for the most part, a single-cell battery suffices for the physician. The inducing wire, as said above, is an extension of the conjunctive wire of the battery, and is comparatively short and thick. About this are coiled numerous turns of fine wire, carefully insulated, and the two coils constitute the bobbin. The reader must now clearly understand that the electricity is induced in the secondary coil only at the moment when the current begins and ends — at the closing and opening of the circuit in the primary coil. Hence, there must be an arrangement for interrupting the current in the primary or inducing wire. This is now accomplished by an ingenious automatic inter- rupter, known as Neef's hammer. This consists of a steel spring terminating in a hammer, of such length that the hammer vibrates in front of the soft iron in the core of the bobbin. On the steel spring, about its middle, is a small plate of platinum, and resting against this is a screw tipped with platinum at its point, and so arranged that the screw regulates the excursions of the hammer or- the rate of its vibrations. This constitutes an automatic interrupter. It is contained in the circuit of the primary coil. Its mode of action is as follows : When the circuit is closed, the soft iron core of the bobbin is at once rendered magnetic, and attracts the hammer to it, and in so doing breaks the cir- cuit at the platina-tipped screw; at once the iron is demag- netized, and the spring draws the hammer back by its own resiliency; then again the circuit is closed, the soft iron is aeain maenetized, the hammer attracted, and thus there ensue regular interruptions. The steel spring is also called " the trembler," from the rapidity of its movements. Although the platina-tipped screw is intended to regulate 70 ELECTRO-PHYSICS. the number of interruptions, it does so to a very limited extent; the vibrations of the spring are very rapid, and can be but sHghtly diminished The hammer of the faradic apparatus invented by the Galvano-Faradic Company, of . ,„ .^r.«.,. - iii ^ "^ ■- 2 ? 3 rt ■S- ^ ^ -§ t- O bx) W el 2 U ^ tj ^ "O ^ c >^ O New York, plays in a fork which enables the operator to regulate the interruptions to any extent (Fig. 39). In the faradic instrument of Flemming, of Philadelphia, the same ELECTRO-MAGNETISM, end is attained by a mechanical arrangement for regulating the rapidity of the interruptions. In an instrument pro- vided with this arrangement, distinct contractions and relaxations of the muscles operated on can be obtained, whilst by the other hammer the interruptions are so rapid as to keep the muscles in a state of tonic contraction. A temporary magnet is also used for securing interrup- tions of the hammer, instead of the screw and core of the primary coil. The mechanism of the construction of a faradic battery will be more readily comprehended by reference to these instructive diagrams from De Watteville. In Fig. 40 we Qr^ have the parts reduced to their simplest expression. The primary coil, an extension of the conjunctive wire, is repre- sented by the line drawn from A to B. The galvanic element is E, and at K is the interrupter. Whenever the current is made or broken at K, an induced current starts in the coil represented by the line from C to D, and the needle of the galvanometer G is deflected in one direction at the making, and in the opposite direction at the break- ing, of the circuit. In the next diagram, another point, viz., the induction between the turns of the coil, is expressed. In Figs. 41 and ri ELECTRO-PHYSICS. 42, we find that a current passing through A B induces a current in C D. Precisely the same effect is exerted be- FiG. 41. (^-^ tween the turns of the coil < ■jT 1) o u ~ ._ y: (LI 'o s 3 H tjO s 'Z U) rt ^ == t: r:: s: V 78 ELECTRO- PHYSICS. which their internal resistance is about equal to the resist- ance on the exterior circuit, the magneto-electric machine must have coils which offer a deo^ree of resistance to the circuit about equal to the resistance of the body. Now, as the resistance of a wire is directly as its length, and in- versely as its sectional area, it follows that a magneto- electric battery for applications to the body should have a coil of longf and fine wire. If, on the other hand, it were intended for electrolysis, or for heating a platinum wire, the resistance being low, the coil should be made of a thicker and shorter wire. Magneto-electric machines are now constructed on a large scale for electric lighting, electro-plating, and other purposes in the arts. Powerful magnets are used, and steam-power is employed to obtain the necessary rapidity of the revolutions. By means of- the ingenious commu- tator already referred to, the currents are turned in one direction, and so transient are the interruptions that the current is practically continuous. It is in a high degree probable that the improvements in this direction will be utilized in the instruments for the medical applications of electricity in the future (Fig. 45). CHAPTER VII. ELECTRO-MAGNETIC AND MAGNETO-ELECTRIC BATTERIES FOR MEDICAL USE. Having set forth the principles on which the construc- tion of faradic instruments rests, it is necessary now to enter into some details in reo-ard to their form and the mode of manaeine them. It would be invidious to decide as to the relative merit of the manufacturers of these in- struments. There are now to be obtained excellent instru- BATTERIES FOR MEDICAL USE. 79 ments from the chief dealers, but the arrangement of the hammer by which very slow or rapid interruptions can be effected is very important, and this point should be looked to in the selection of an instrument (Fio-. 43). Besides the gradation in the interruptions, batteries should possess Fig. 47. Kidder's faradic battery, with " tip cup." means for regulating the force of the current from a faint scarcely perceptible tingling to the most intense burning pain. The elements should be portable and not spill when carried about, and there should be an arrangement for lift- mg the zinc out of the fluid when not in use (Fig. ^^j). 80 ELECTRO-PHYSICS. The Grenet cup fulfils these conditions, and this, or some modification of it, is now chiefly used. Kidder has invented a " tip cup," which is so arranged that when the battery is not in action the cup is turned over and the fluid flows into a diverticulum (Fig. 47). Every faradic battery should have a movable cylinder for modifying the strength of the current, and should furnish the extra and secondary cur- rent. The " primary current," so called, is reinforced by induction between the turns of the coil and the core of soft iron, and is chiefly the " extra current" of Faraday. Those who suppose that the primary current is merely a galvanic current derived from the cell, or cells, are greatly deceived, and yet there are many who entertain this notion, misled by the term.. Fig 4S. Fir.. 49. Flemming'b faradic battery. Hall's faradic balteiy. A most convenient and portable battery is that of Gaiffe. It is in the shape of a post 8vo, book, and may be carried in the pocket, llie zincs are acted on by the bisulphate of mercury, and the usual coil, rheotome, cylinder, and BATTERIES FOR MEDICAL USE. 81 electrodes are contained in the box. This arrangement furnishes a current of sufficient strength for many pur- poses, and is especially adapted to outside practice (Fig. 51). Several models of the same form of battery are now Fig. 50. Faradic apparatus for office table. Fig. 51. Gaiffe's sulphate of mercury pocket battery. made in this country, and they possess all the merits of the foreign instrument, and are, I believe, cheaper in price. In the purchase of a faradic instrument, the reader should bear in mind the importance of an arrangement for slow 6 82 ELECTRO-PHYSICS. interruptions. Although the screw of the Neef's hammer permits some variation in the number of interruptions, it does jiot admit of the slow breaks in the circuit effected by the fork and hammer of the Galvano-Faradic Company, or the rino- and lever arrano-ement of Flemming-. The im- portance of this point consists in the fact that rapid inter- FiG. 52. Combination battery. ruptions throw the muscles into a tetanic state, whereas, by the other arrangement, distinct muscular contractions, with intervals of complete relaxation, are assured. Besides the battery, certain accessories are required. Wires of sufficient length for ready application of the BATTERIES FOR MEDICAL USE. 83 electrodes, and a variety of electrodes are necessary. The wires should be of copper of considerable thickness, and should be well insulated. The need of preserving the pliancy of the wire has led to the use of silk and woollen materials for insulation, but when these become wet they no longer insulate, and they usually wear out very soon. On the whole, the best material is telegraph wire coated with gutta-percha. This is sufficiently flexible, and the coating can be removed with the knife when connections are to be made. The best electrodes are carbons of vari- ous forms, having hard-rubber handles. The carbons are covered with wash leather or soft sponge. As these sponges should be frequently renewed, certainly daily when they are much used, reef sponge should be selected, both on account of cheapness and superior softness. Over the leather or sponge may be tied some gauze which can be renewed at each application, as the cost is trifling, and thus an entirely cleanly and acceptable electrode is employed, greatly to the comfort of fastidious patients. When general electrization by the faradic current is to be prac- tised, large electrodes should be used, but when nerve or muscle applications are to be made, the electrodes must be small. For isolating, and for application to individual muscles, Duchenne's electrodes are very useful. They are olive-shaped and curved to facilitate application by a single hand. There are electrodes for the phrenic nerve, for the larynx, rectum, bladder, vagina, uterus, and other organs, a broad copper plate for the feet to rest on, a brush for the skin, and needle electrodes for electrolysis. The various forms will be again referred to in connection with the particular purposes for which they are used. All the principal dealers now furnish combined galvanic and faradic combinations in one box, intended both for office use and for outside practice. They are arranged to be transported without spilling the fluids. Although these 84 ELECTRO-PHYSICS. are excellent in their way, great annoyance is caused by the difficulty of keeping them in good working order. The elements require frequent changes to maintain their activity at a proper level, and the connections are apt to become broken by corrosion of the metals. Only those should undertake the care of complex arrangements of this kind who are familiar with principles and the mechanical details (Fig- 50- Galvano-Faradization. — This process consists in the application of the combined currents. In 1882 De Watte- ville published an investigation into the physiological action of the combination. Stein,' Schleicher,^ and others have applied this method with success, especially in the form of the electric bath, and douche. The more modern pole-boards are now provided with arrangements for unit- ing the currents and thus supplying to the electrodes both galvanic and faradic electricity, at the same time and in the same conducting wire. The Electric Bath. — First employed by the merest charlatans, electric baths have at length received the coun- tenance and support of many eminent electro-therapeu- tists. The author did not consider this subject in the previous editions of this work, because of a conviction that the method is uncertain and unscientific. But having been adopted by such men as Dr. Schweig, of New York, Eulenberg, Stern, and others of Germany, it is necessary to devote some space to it, to set forth its methods, and determine its real place as an electrical remedy. The electric bath consists in the application of galvanic, faradic, and galvano-faradic currents, through the water in which a part, or the whole of the body is immersed. Although water is a conductor of electricity, it is but a poor 1 Galvano-faradization. Neurolog. Centralblatt, No. 8, 1883. ^ A. Schleicher. Ueber Farado-electrische Bader. Wiener med. Presse, No. 27, 1883. THE ELECTRIC BATH. 85 one, and offers a high degree of resistance to the passage of the current. This fact is illustrated in the water rheostat, which is interpolated in the circuit to lessen its strength. The degree of resistance offered is in proportion to the thickness of the stratum interposed between the battery- terminals and the body of the patient. This resistance may be lessened by dissolving some common salt in the water, when besides the increased readiness of conduction, an electrolytic effect is obtained. Various patented contrivances have been introduced for the application of baths. Some of these are arranged as cabinets in which medicated vapors, steam, and water baths are given singly and in combination. Such complicated machinery is better adapted to the use of institutions and specialists who do not disdain the aid of clap-trap in pro- curing their results. If the legitimate practitioner desires to make use of the electric bath, simple arrangements suf- fice. An insulated bath-tub, with connecting rheophores, is the sole requirement necessary for a full bath, whilst single parts, as the hand or foot, can be immersed in water in a wooden basin with which the battery terminals can communicate. Electric baths are monopolar, or dipolar; simple or medi- cated ; galvanic, faradic, or galvano-faradic. All parts of the body except the head immersed, the terminal wires dipping into the water, the circuit is made, and thus through the water the current reaches the whole external integu- ment. Obviously in this way the method of general elec- trization is practised. When both terminals are in the water, the bath is dipolar; when one extends into the water, and the other is held by the patient, or applied to some part not covered by the water, it is monopolar. The physiological effects of electric baths have been 86 ELECTRO-PHYSICS. Studied by Lehr,' Stein,^ Trautwein,^ Eulenburg/ and others. It is agreed that the dipolar bath is an equivalent of gen- eral faradization. The current diffusing widely from the battery terminals, the strength of the application decreases in an inverse proportion with the distance of the body from them. (Lehr.) Although Lehr obtained no decisive cata- phoric or electrolytic action, he was able to ascertain that in faradic baths of ten minutes duration, the electric sensi- bility is increased, whilst a distinct diminution of motor excitability takes place. The cutaneous sensibility to fara- dic stimulation is for a brief time increased, but afterward considerably lessened, whilst to the galvanic, the diminu- tion of cutaneous sensibility occurs at once and is main- tained throughout. At first, both in faradic and galvanic baths of moderate strength, the frequency of the pulse is lessened after a time, to return to the normal. With a powerful and long-continued current action, the frequency of the pulse increases during the bath, the tension of the vessels is elevated, and sometimes there is irregularity in the action of the heart. As respects the respiration, in dipolar baths, galvanic and faradic, the number of the res- pirations is increased, and in volume deepened, whilst in monopolar this effect is much less pronounced. The tem- perature is little affected in dipolar baths, but is lowered in the monopolar. As respects the excretion of urea, the effect of the dipolar bath, galvanic and faradic, is much greater than the monopolar. All forms of electric baths stimulate the appetite, increase the digestive power, pro- ^ Lehr. Dr. G. Die hydroelectrischen Bader, ihre physiologische und thera- peutische Wirkung. Wiesbaden, 1S85. "'' Ueber die Fortschritte der Tecknik bei der Application electrischer Bader. Versamml. Deutsch. Naturf. und Aerzle in Strassburg. Virchow u. Hirsch's Jahresbericht for 1885. ' Abstract in Virchow und Hirsch's Jahresbericht for 1884. * Eulenburg A. Ueber electrische Bader. Deutsche med Zeitung, No. 44, 1884. THE ELECTRIC BATH. 87 mote intestinal peristalsis, and affect agreeably the mental state. Also, sleep is promoted and various functional ner- vous affections improved. As Stein has shown, the monopolar is not as well adapted to the treatment of disease as the dipolar bath, because of the great difference of current density between the im- mersed surface, and that part to which the other electrode is applied. In the dipolar bath the current density does not fluctuate, and the polarization is at the minimum — whence its superiority as a remedial agent. Schleicher' has followed Stein's method, and also uses faradic baths, employing the dipolar and Stein's shovel- shaped electrodes. He finds that the frequency of the pulse is lessened 8 to 20 beats, the general feelings im- proved, and the mental activity increased. Eulenburg^ holds that the monopolar bath, by the various modes of its use, especially when some part of the body of the patient is in contact with one of the electrodes allows such varia- tions in the current strength, that this form of bath is quite unsuited to scientific work. The dipolar bath — in which the patient receives the elec- trical current as diffused throup^h the water — is, as before stated, merely a means of general electrization. It has the advantage of the simultaneous application of the current to all parts of the body. The quantity actually acting on the integument will vary with the thickness of the stratum of water interposed. In Beard's method of electrization, the electrode must necessarily be moved over the surface ; in the electric bath the contact of the current with the sur- face is simultaneous. As patients receiving electrical treatment desire to feel the current, they are apt to complain, when in the dipolar bath, that no effect is produced. Under these circum- ^ Wiener med. Presse, No. 27, 1884. * Op. cit. ELECTRO- PHYSICS. Stances, dishonest electricians are given to place the elec- trodes in contact with the body, thus preventing the effects really due to an electric bath. What advantages soever the method of electric baths offers to practical therapeutics, it is my conviction that the difficulties of their use more than compensate. Neverthe- less, they are now recognized as legitimate means of elec- trical treatment, and are employed, with the necessary limitations, by Paul,' Bernhardt,^ Ischewsky,^ and others, besides those authorities mentioned above. CHAPTER VIII. CARE OF BATTERIES, GALVANIC AND FARADIC: MANIPULATION. It cannot be too strongly impressed on those who pur- pose providing themselves with electrical apparatus, that both galvanic and faradic appliances are necessary. It must also be insisted on, that large elements with two fluids furnish a current capable of better therapeutical re- sults than small elements with a single fluid. The former, also, require much less care. The Siemens and Halske cup, and the gravity battery, which are the best for medical purposes, require but little attention after they are once put up. A few crystals of sulphate of copper, and a little water to supply the loss by evaporation, need to be added from time to time. The portable battery of one fluid re- quires a great deal of attention. When freshly charged, the action at once attains the maximum, and then declines. There are, therefore, considerable variations in the tension 1 Paul, Dr. C. Bui. Gen. de Therap., No. ii, 1881. "^ Bernhardt M. Berliner klin. Wochenschr., No. 31, 1883. ^ * Ischewsky. Virchow und Heisch's Jahresbericht, 1882, vol. i. GALVANIC AND FARADIC BATTERIES. 89 from time to time. As soon as the application is ended, the elements should be raised out of the fluid. As the fluid rapidly changes and loses strength, it should be often re- newed,^ the elements washed, the zincs amalgamated, and the carbons occasionally baked. After every immersion the elements should be washed and dried. The commu- tator and current selector of the portable battery are apt to become oxidized, and hence the communications fail. All of the connections should be rubbed daily with emery paper to keep them bright. The portable batteries now made, such as the chloride of silver, "the chloride," the Partz battery, and other forms, with or without fluid, are all so arranged that transportation is no longer difficult, and spilling of the contents of elements cannot occur. Batteries should be protected from dust, grease, and moisture. A small particle of dust interposed between conducting parts, or a little grease, may interrupt the cur- rent. If the battery does not work, the fault may be at various points. It may be in the pole-wires or connections with the electrodes. These should be carefully examined. The fault may be on the pole-board. Does the needle of the galvanometer move when the wire of the positive elec- trode is brought in contact with the post of the negative, and not when the negative is brought against the post of the positive ; then the failure is in the negative electrode or its wire. If the test is reversed, the failure is in the positive. Next, each part of the pole-board, the stops, the commutator, rheostat, interrupter, etc., should be examined in turn; then the connections of the wires leadingr from the cups to the buttons on the pole-board; and, lastly, the com- ' In a battery of Smee's elements, the exciting fluid consists of sulphuric acid, diluted — one part of the acid to fifteen parts of water. The fluid of the zinc-carbon batteries consists of sulphuric acid and bichromate of potassium — two ounces of the acid, one ounce of bichromate of potassium, and sixteen ounces of water. The water and acid should be mixed first, and, when cold, the bichromate of potassium added. 90 ELECTRO-PHYSICS. munications between the cups, until the fault is found. If the galvanic battery has been completed, how determine the position of the poles — which is positive, which nega- tive ? Prepare some starch mixture, and add to it a few crystals of iodide of potassium ; when the electrodes are immersed in this fluid, iodine appears at the positive pole, forming the blue iodide of starch. It has already been pointed out that the zinc surface in the battery, where the chemical action is going on, is positive; but that the current outside passes from the copper to the zinc, whence the zinc is the negative pole, and the copper the posi- tive. If the battery is in working order, how determine the strength of the application ? The number of cups brought within the circuit is the first rough mode. The best test of the strength of the current, for very delicate applications, in the absence of an absolute galvanometer, is the tongue of the operator ; and, for the coarser, the hand. If, however, the operator is provided with an absolute galvanometer, the application of current strength becomes more precise — the number of milliamperes being read off the scale, as degrees on a mercurial thermometer. The usual strength of application ranges from i to 20 milliamperes. When the number of elements is the guide to the strength of application, it will be convenient to remember that the Daniell has an electro-motive force of I volt; the zinc-carbon (Stohrer, Grenet, etc.) of 1.5 volts, and the Leclanche of 1.3 volts. Roughly, 3 Daniell's are estimated to be equal to 2 Leclanche, Having de- cided on the number of milliamperes to apply, it is far better to obtain them by using a large electro-motive force (volts), and interposing sufficient resistance (ohms). The current thus obtained will not vary in tension, and, if changes in strength are required, resistances may be taken out or added, as may be necessary. Especially ought the strength of the current be carefully determined before GALVANIC AND FARADIC BATTERIES. 91 applying galvanism to the face or head. The size of the electrode greatly influences the merely local effect of the current. If a large volume of galvanic electricity is made to traverse a small electrode, it is introduced into the skin in a very condensed form, and therefore causes a severe burning pain, which, if distributed over a larger area, would produce but little effect. It need hardly be asserted that metallic electrodes, conducting rapidly, are more irritating than sponge-covered electrodes. Formerly the induction machines were supplied with a brass cylinder electrode, the only mode of application then practised consisting in holdino- the electrodes in the hands. Strange as it may appear, very little was known of moist- ened electrodes up to the time of Duchenne de Boulogne. The importance of the suggestion proved to be very great, for the skin offers a strong obstacle to the passage of elec- tricity, owing to the dryness of the epidermis. The con- ductivity of the tissues in general is directly as their degree of moisture. Much of the electricity is converted into heat in the attempt to traverse the dry epidermis, and hence does not reach the parts beneath. By thoroughly moist- ening the epidermis by wet sponge electrodes, the con- ductivity of the skin is so increased that the nerves and muscles are readily reached. On the other hand, if it be desired to confine the action to the skin, as is sometimes the case, it is thoroughly dried, and also dusted with some drying powder. In some cases of neuralgia, electrical ex- citation of the skin has a good effect, but the current must be prevented passing through the skin by the expedient above described. In making mild applications of galvan- ism to persons having little power of appreciation of local sensations, it is well to add some common salt to the water with which the electrodes are moistened. This in- creases the conductivity of the skin and consequently the sensibility to the current. 92 ELECTRO-PHYSICS. It is a fundamental principle that electrical applications must be made to the affected part. This fact, which we also owe to Duchenne, was emphasized by him in the title of his work, De f ElectjdsatioTi Localisee. To this principle may be added the further one — electrical applications should also be made to the parts where decided symptoms are ex- perienced. There are some exceptions to these rules, as, for example, in central galvanization employed in the treat- ment of constitutional states, etc. Certain terms have been established by usage to designate the kind of application practised. Thus when the poles are kept in a fixed posi- tion, the applications are said to be stabile, and when they are moved over the surface, labile. The difference between them is considerable; for, while the stabile applications are constant and uninterrupted, the labile are rapidly inter- rupted in proportion to the rate of movement over the sur- face. When the current descends from the centre to the periphery, it is called a direct or descending current. If the current pass in the opposite direction, it becomes the in- verse or ascending. General electrization is a term employed to designate a method of application in which the whole of the surface is in turn acted on. Galvanism or faradism may be so applied, but the method is advocated chiefly by Beard and Rockwell, who apply the faradic current, the feet resting on a copper plate connected with either the anode or cathode, whilst the other pole is passed over every part of the body. General electrization may also be accomplished by static electricity. The patient stands on an insulated stool, one hand in contact with the prime con- ductor of an electrical machine, and is charged with posi- tive electricity. Sparks may be drawn from any part of the body. Local applications are intended to affect muscles and nerves. A muscle may be acted on directly or indirectly. Thus, when the muscle is directly reached by moistened GALVANIC AND FARADIC BATTERIES. 93 electrodes placed over it, the application is designated direct. If one electrode is placed over the motor nerve and the other on the belly of the muscle, the application is said to be indirect. The direction taken by the current is determined by the position of the electrodes and the char- acter of the tissues traversed. The current, in large part, passes by the most direct route from one electrode to the other, but not entirely so; much of it passes by the lines of least resistance. If the electrodes are placed on the arm, as indicated in the figure, the current affects the muscles of the arm, because of its effusion. If the electrodes are still more approximated, the diffusion of the current takes the direction indicated in this schematic representation (Fig. 53), and the muscles are acted on accordingly. By Duchenne, the contraction of the muscles occurring at re- mote points was referred, not to diffusion of the current, but to reflex action, but he was mistaken in this assump- tion. The degree of diffusion of the current is affected somewhat by the size of the electrodes — the larger the electrodes the more wide the diffusion of the current. The electrodes may be never so small, and yet some diffusion will take place. The force of the current is also concerned, for the stronger the current the more diffusion. Many of the phenomena of diffusion are due to ''derived currents " (E. Onimus et Ch. Legros'). The> are easily explained ^ Traite d' Electricity Medicale, Paris, 1872. 94 ELECTRO-PHYSICS. Fig. 54. by reference to the subjoined diagram (Fig. 53) : Give a circuit formed by A, B, C, and D. Let the positive pole be placed a A and the negative at B. The chief part of the current will take the direction from A by C to B ; but at the same time there will be a derived current passing from A by D to B. The more decided the resistance be- tween A and B, and the greater dis- tance between them, the more con- siderable the volume of electricity from A to B by D. The influence of derived currents is shown in the wide- spread reactions which ensue when the poles of the battery are placed at certain points on the body. When a strong current is passed through the electrodes, one on the neck and the other on the lumbar region, a metallic taste is experienced in the mouth, there are flashes of lisfht from the eyes, and a rumbling noise is heard in the ears. These facts are illus- trated in Fig, 54, taken from Erb. If the positive electrode is applied at A, and the negative at B, the current diffuses as indicated by the curved lines, through the body. The major part passes by the nearest route from A to B, but more or less deflected to follow the lines of least re- sistance. The derived currents are from A to a and from B to b, outside of and beyond the interpolar. The more widely separated the poles, the greater the diffusion. Sec- ondary currents, about which little is known, however, are produced on the opening and closing the galvanic current. PART II. ELECTRO-PHYSIOLOGY. CHAPTER I ANIMAL ELECTRICITY. In certain fishes there exists an apparatus for generating electricity not unHke the cups in a galvanic combination. These fishes are the electric eel [Gynuwhis electricus), the electric ray {Torpedo vulgaris), and the electric shad {Malapteriiriis electidcus). The electricity which the elec- tric organs of these animals generate is precisely the same as that produced by galvanic combinations. The proof of this statement is afforded by the following facts: The elec- tricity of these fishes will magnetize iron, decompose water or a solution of iodide of potassium, deflect the needle of the galvanometer, etc. As in a galvanic battery, the electro-motive force is due to the amount of the chemical action, so in these electric fishes, the quantity of electricity produced by them is in a precise ratio to the functional energy displayed by the organs of circulation and of res- piration. Both the gymnotus and the torpedo possess an electric organ composed of membranous prisms, arranged like the cells of a honeycomb, and each prism is subdivided by horizontal diaphragms into small cells containing an albuminous fluid. The diaphragms are electro-positive on one surface and electro-negative on the other, and between them is an electrolytic albuminous fluid having an acid re- 96 ELECTRO-PHYSIOLOGY. action. The electric organ of the malapterurus differs somewhat from the others in the arrangement of its cells, which are contained in a tube surrounding the fish, and extending from head to tail. This tube is intimately con- nected with the skin, and is divided by a membranous septum into two lateral halves. The electrical organ of each variety of electrical fish is connected with the central nervous system by large nerves, numerous filaments being distributed to the cells. In the torpedo the electric organ communicates by four large nerves with the fourth lobe of the brain, irritation of which is followed by strong discharges of electricity. A similar arrangement exists in the gymnotus, but in the malapte- rurus the nerves communicating with the electric organ arise from the spinal cord, between the second and third spinal nerve roots. The activity of the electric organ is destroyed by coagulating the albuminous fluid of the cells ; by chemicals which injure the nerves ; by section of the nerve-trunks connecting the organ with the brain or cord ; by placing the fish under the influence of ether or woorara, etc. Discharges are received by touching the fish at any point, but in the malapterurus the most powerful shocks are felt when the head and tail are simultaneously touched. The discharges of the electrical organ are also under voluntary control, and are employed for defence against enemies, and to benumb their prey. Frequent discharges exhaust the resources of the organ, and a period of repose is then necessary to enable it to recover its powers. Although other animals are not possessed of an electri- cal organ, electrical currents circulate in them. Galvani was the first to demonstrate the existence of these currents, but the most important contributions to our knowledge have been made by Matteucci and Du Bois-Reymond. As developed by the latter especially, and by the labors of ANIMAL ELECTRICITY. 97 Pfliiger, Von Bezold, and odiers, in Germany, electro- physiology has reached enormous proportions, but its ab- struseness has deterred all except the most zealous workers from its study. Undoubtedly the subject is undergoing a transition, and the conviction is growing that it needs care- ful revision with the improved knowledge and methods of research now available for the purpose. So uncertain is the condition of the subject, so doubtful the accuracy of much of the supposed knowledge, and so little available for application to medical electricity, that it will be best to give here only the slightest sketch of those facts which seem most firmly established. Matteucci held that the electro-motive force of animal electricity is derived from the muscles, and that the nerves are mere conductors, participating in the electrical con- dition of muscles at the points of contact with the latter only. Du Bois-Reymond has, however, proved that there are currents in nerves as well as in muscles. The natural tT-ansverse section of a muscle is the base of the fibres ter- minating in the tendon, and the natural longitudinal section is the surface of the muscle. The artificial transverse section and the artificial loncritudinal section are divisions o of the muscle carried to any degree of minuteness, and made in the same direction as the natural sections. It is found that the direction of the current is from the natural longitudinal section to the natural transverse section — in other words, in the direction of its fibres. The same fact is true of any artificial section of the muscle. The follow- ing formula expresses these facts : " Each point on the longitudinal section of a muscle is positive in relation to points on the transverse section, whether natural or artificial." This law, deducted by Du Bois, has been confirmed by observations on the muscles of an amputated limb of man, and on the muscles of 7 98 ELECTRO -PHYSIOLOGY. various animals. Electrical currents are also obtained by contact with the electrodes of the galvanometer, with two points on the same surface, provided they are not equidis- tant from the median section, and that point nearest the centre is positive in relation to that point which is most remote. The same fact is true of the transverse as well as of the longitudinal section. The intensity of currents obtained from the same section is greatly less than that obtained from different sections. Acting on different mus- cles, it is found that the current is more intense in those muscles having the highest functional activity. Thus the muscle of the heart furnishes the most active, whilst the muscle of the intestine furnishes the least active, current. There are currents in nerves as in muscles. A current moves from the longitudinal section of a nerve (its exter- nal surface) through the galvanometer to the transverse section, and the points which are nearest to the middle of the nervous fragment are positive in respect to those which are nearer to the extremities. The same law holds true as regards the brain. Every artificial section of the brain is negative to every point of its natural surface. During the contraction of a muscle, or during the active state of a nerve, the natural currents diminish, or indicate a negative deviation. When a nerve, fresh and excitable, is acted on by a galvanic current, a remarkable change takes place in its condition. This change is called the electrotonic state, and is induced not merely by the passage of a galvanic current, but involves an actual alteration in the electrical proper- ties of the nerves. That such is the fact is proved by tying a wet thread tightly around the nerve, which does not interfere with the transmission of the electric current, but does entirely prevent the development of the electro- tonic state. If the galvanic current moves through the ANIMAL ELECTRICITY. 99 nerve in the same direction as the nervous current, the intensity of the latter is increased : whence there is de- veloped the positive phase of the nei-ve, according to Du Bois-Reymond. The nerve current is diminished in inten- sity by the passage of the galvanic current in the opposite direction — whence the negative phase of the nerve. The electrotonic state continues unchanged as long as the cur- rent is passing, but disappears on breaking the circuit. All electrical phenomena of every kind cease when the vitality of the nerve is destroyed. The same fact is true of the muscles. Electrical manifestations decline after the death of the animal, and cease entirely when rigor mortis sets in. The discoveries of M. Becquerel in electro-capillarity are very important. He has ascertained that electro-chemical circuits are produced between two liquids separated by a membrane. That part of the membrane in contact with the liquid acting as an acid, is the negative pole, and the opposed surface is the positive pole. The different ana- tomical elements — cells, tubes, globules, and their liquid connections — form electro-capillary couplets. Becquerel has shown that a muscle In contact with respired oxygen is in the same condition as in presence of the blood, but the results are not exactly the same, and when the muscle is disorganized, reduced to a paste, it consumes a quantity of oxygen double that used by a muscle which is entire and of the same weight. If the intact muscle, and the muscle reduced to a paste, are placed on a plate of pla- tinum, and another platinum plate introduced into the interior, a current is found to pass from the interior to the exterior, as shown by the deflection of the needle of the galvanometer ; the exterior is positive, and the interior negative. As the exterior is in contact with the oxygen of the air, and is oxidizable, it is a reasonable presumption 100 ELECTRO-PHYSIOLOGY. that this is the determining cause of the muscular current passing from the exterior to the interior. It follows, ac- cording to this view, that electrical currents in muscles have their origin in chemical action. This view is strongly sup- ported by the experiment in which the muscle is immersed in nitrogen or hydrogen. Under these circumstances the current passing from the exterior to the interior lessens, then ceases, and finally passes in the other direction, be- cause of the oxidizable materials still present in the inte- rior. Further experiments by Becquerel have shown that there exist numerous electro-capillary currents between the blood and the liquids in the muscles. In the arterial blood, oxygen is fixed in the haimatosin by capillary affinity. That face of the capillary in contact with the arterial blood is the negative pole, and the opposed face next the muscular fluids is the positive pole. ACTION OF GALVANISM ON NERVES. 101 CHAPTER II. ACTION OF THE GALVANIC CURRENT ON MOTOR, SENSORY, AND MIXED NERVES. It will assist the reader to comprehend the action of galvanic currents on nerves, if the account of these phe- nomena is preceded by some observations on contraction of muscle, for it is by muscular contraction that many of the nervous actions are interpreted. Muscular tissue is composed of contractile elements, which have the power to shorten themselves when acted on by certain stimulants. This property is called ir?^ tab i lily, and Hallerian irrita- bility, because first supposed to exist by Haller. If a muscle, fresh and uninjured, be irritated by pinching, by chemicals, or by galvanism, it will at once contract — i. e., shorten in its long diameter and bulge at the sides. When left undisturbed, the muscle remains entirely quiet; but when irritated, it contracts. It is not necessary that the irritation be applied directly to the muscle. Con- traction will ensue in the muscle when the motor nerve supplying it is subjected to irritation. The nerve, also, possesses the property of " irritability," but no change takes place in its form or appearance when it is subjected to irritation. It may undergo some molecular modifica- tion, but the nature of this is unknown. The impulse originating in the nerve by irritation is communicated to the muscle, and contraction of the muscle takes place. The muscle-nerve preparation for demonstrating a muscu- lar contraction consists of the gastrocnemius, with the sciatic attached, of the frog. The nerve is acted on by the electrodes of an induction machine, and the muscle is 102 ELECTRO- PHYSIOLOGY. A. The moist chamber containing the muscle-nerve preparation. (The muscle-nerve and electrode-holder are shown on a larger scale in Fig. 56.) Them scle w, sup- ported by the clamp c/, which firmly grasps the end of the femur/", is connected ACTION OF GALVANISM ON NERVES. 103 by means of the S hook s and a thread with the lever /, placed below the moist chamber. The nerve n, with the portion of the spinal column n^ still attached to it, is placed on the electrode-holder e/, in contact with the wires x y. The whole of the interior of the glass case gl, is kept saturated with moisture, and the Ciec- trode-holder is so constructed that a piece of moistened blotting-paper may be placed on it without coming in contact with the nerve. B. The revolving cylinder bearing the smoked paper on which the lever writes. C Du Bois-Reymond's key arranged for short-circuiting. The wires x and j/ of the electrode-holder are connected through binding screws in the floor of the moist chamber with the wires x'j'', and these are secured in the key, one on either side. To the same key are attached the wires x^' y'^, coming from the secondary coil s c oi the induction machine D. This secondary coil can be made to slide up and down over the primary coil/r c, with which are connected the two wires x"^ andjj/^^''. x^^' is connected directly with one pole, for instance, the copper pole c p of the battery E. y"^ is carried to a binding screw a of the Morse key F, and is continued asy'' from another binding screw b of the key to the zinc pole z p of the battery. Supposing everything to be 'arranged, and the battery charged, on depressing the handle ha^ of the Morse key F, a current will be made in the primary coil /r c, passing Irom c p, through x'" \.o pr c, and thence through _j''^^ to a, thence to l>. and so through y" to z p. On removing the finger from the handle of F, a spring thru'-ts up the handle, and the primary circuit is in consequence immediately broken. At the instant that the primary current is either made or broken, an induced current is for the instant developed in the secondary coil j- c. If the cross-bar h, in the Du Bois-Reymond's key be raised (as shown in the thick line in the figure), the wires x^^^ x\ x, the nerve between the electrodes, and the -wxres y, y\y'^ , form the complete secondary circuit, and the nerve consequently experiences a making or breaking induction-shock whenever the primary current is made or broken. If the cross-bar of the Du Bois-Reymond key be shut down, as in the dotted line Ji' in the figure, the resistance of the cross-bar is so slight compa.ed with that of the nerve and of the wires going from the key to the nerve, that the whole secondary (induced) current passes from x'^ io y'^ (or fromj)/^^ to x") along the cross- bar, and none passes into the nerve. The nerve, being thus short-circuited, is not affected by any changes in the current. Fig. 1^6. The muscle-nerve preparation of Fig. 55, and the clamp electrode, and electrode- holder are here shown on a larger scale — the letters as in Fig. 55. The form of elec- trode-holder figured is a convenient one for general purposes, but many other forms are in use. 104 ELECTRO-PHYSIOLOGY. arranged so that its movements can be recorded on a re- volving cylinder. The whole apparatus is represented in Fig, 55 and Fig. 56 (from Foster's Physiology). A muscle-curve obtained by this apparatus has the form shown in Fig. 57. We learn from this that a muscular A muscle-curve, a indicates the moment when an induction-shock is sent into the nerve; ^, the commencement; r, the maximum; and one knob on the sacrum and the other against the pubes, proved decidedly beneficial in cases of amenorrhcea. As Dr. Bird says : "Scarcely any cases have been submitted to electrical treatment in which its sanatory influence has been so strongly marked as in those in which the men- strual function was deficient. . . . The rule for in- suring success in the great mass of cases of amenorrhcea is sufficiently simple : improve the general health by exer- cise and tonics ; remove the accumulations often present in the bowels by appropriate purgatives ; and then a few electric shocks, often a single one, will be sufficient to produce menstruation, and at once to restore the pre- viously deficient function" (p. 114). APPLICATIONS OF STATIC ELECTRICITY. 151 "A further report on the value of electricity as a remedial agent," appeared in 1851, from another member of Guy's Hospital staff — Dr. now Sir William W. Gull.' By this time faradism was being urged by Duchenne, and galvanism by Remak. Dr. Gull, in comparing the effects of these different modes of electrical energy, decides in favor of the superior efficacy of static electricity. "I have tried." he says, "such currents, both direct and inverse, in several cases of tic douloureux and other forms of neuralgia without benefit Neither has it appeared to me that any practical advantages have re- sulted from employing shocks from the direct current in paralysis." In 1873, Dr. Wilks,'' another eminent member of Guy's Hospital staff, thus expresses himself on the subject of the change of practice in the substitution of galvanism and faradism for static electricity: "After the introduc- tion of electro-magnetism or faradization, frictional elec- tricity fell into disuse ; but I feel confident that it was not successfully superseded by the new method." That which Dr. Wilks has to say in regard to the electrical treatment of chorea is probably true of some other disorders in which galvanism and faradism are now used. The modern revival in the use of statical electricity is more especially due to Charcot and his pupils, especially to Dr. Arthius,3 and afterward to Dr. Vigrouroux, of Paris. The efforts of Guy's Hospital men extended but little in- fluence beyond their own circle. In this country, Dr. W. J. Morton, of New York, the author, and Dr. George M. Beard, were most active in introducine the new view of statical electricity into the literature and medical practice of this country. ^ Guy's Hospital Reports for 185 1. - Ibidem for 1873. ^ L'Electricite Statique et L'Hysterie, etc., par le Dr. Arthius, Paris, 1881. Dr. Arthius controverts the claim of Dr. Vigouroux as the pioneer in the use of static electricity in hysteria. 162 ELECTRO-THERAPEUTICS. The Apppliances of Statical Electricity. — Static elec- tricity may be applied by means of the plate, the cylin- der, or the Holtz machine. The last mentioned, as it has been lately improved, is both highly efficient and certain in operation. The instrument used by the author is a Toepler-Holtz machine, as made for me by James W. Queen & Co., of Philadelphia. Although this machine works with great uniformity, and can always be depended on during the whole of that part of the year in which artificial heating is necessary, yet when the warm season comes on, it fails in constancy, as do all other statical machines. To obviate this disadvantage, the author has had made by Messrs. Queen & Co., the arrangement shown in Fig. 60. In this, the electrical machine is con- tained in an air-tight case, whilst the handle and dis- charging rods are placed externally. As the operator, in applying statical electricity, often needs both hands in manipulating the electrodes, this arrangement is provided with a pedal by which it is easily worked. When there is sufficient pressure in the water-pipes, a water-motor, such as the "Backus," may be used to work the machine. Having had experience with both modes of working small machines, I find that, on the whole, the pedal arranpfement is the more useful of the two. The Holtz machine has been variously modified by dif- ferent makers, and, as a rule, improved. In the Toepler- Holtz the windows have been omitted from the fixed plate. On the revolving plate are clamped at regular intervals brass knobs, against which some bunches of tinsel {a, a', Fig. 60) are arranged to brush. In my instrument the brush attached to a is composed of brass wire, stiff enough to scratch with some force. The orio-inal instrument was capricious, and was not, therefore, suited to purposes which demand, above all things, constancy and uniformity. The simplest cylinder or plate machine will, however, be APPLICATIONS OF STATIC ELECTRICITY. 153 sufficient for medical uses, provided it works well under all circumstances. Positive or negative electricity can be obtained — positive from the prime conductor, and negative Fig. 6o. The Toepler-Holtz electrical machine in air-tight case. from the rubber. The electricity may be communicated to the patient by conduction, or by disruptive discharge. The patient placed on an insulated stool, body in com- munication with the knob of the prime conductor, or the rubber cushion, becomes charged with positive or nega- tive accordingly. I am unable to discern any difference in physiological or therapeutical effects, in the actions of the two forms of franklinic electricity. 154 ELECTRO-THERAPEUTICS. General Franklinization.' — Placed on the insulated stool, as mentioned above, the patient is more or less highly charged with electricity, which is silently received without pain, as it does not pass by disruption. The hair is deflected from the scalp, the surface becomes warm, the cutaneous circulation is active, the face flushed, the action of the heart is quickened, and the pulse is more rapid. A general sense of tingling in the skin is experienced, and an abundant perspiration breaks out over the body. If now the knuckle of the operator, or a brass knob, is pre- sented to any part of the body, a spark passes with a stinging sensation, and a wheal is ultimately formed. An insulated stool may be made by placing a strong board having the proper dimensions on four or more stout glass tumblers. An ordinary chair may be insulated by putting on the legs the rubber tips now constructed for preventing damage to the carpet or floor. A brass chain of the size used with electrical machines is a convenient means of connecting the patient with the machine. The operator will hnd it rather painful to draw off sparks with his knuckles, and hence should use an insu- lated brass knob, havincr a suitable handle and a chain communicating with the floor. It is also convenient to have a loop, by means of which the chain is held away from the patient — for painful sparks pass on contact. If the machine has sufficient power, sparks can be drawn through the clothing, but much more pain is given than when drawn from the skin immediately. Nerve and Muscle Effects of Statical Electricity. — About the same time. Dr. W. J. Morton, of New York, and the author, ascertained that effects in no respect distinguish- able from those produced by faradic electricity could be pro- ' In previous editions of this work the phrase, " Electric Bath," was em- ployed. As this phrase is now devoted to a process in which electricity is given by means of a bath, I have substituted "General Franklinization." APPLICATIONS OF STATIC ELECTRICITY. 155 cured from the Holtz machine. Dr. Morton begins by separating the outer coating of the condensers (/, ?', Fig. 60), accomphshed by removing the communicating bar underneath the platform. By attaching to the base of the condensers orcHnary rheophores and electrodes, and plac- ing the discharging rods (;-, Fig. 60) in communication, the current is drawn off I find the current can be easily tapped without displacing any part of the machine, as follows : I fasten one brass chain to the top brass knob of one con- denser — the left-hand one facing the machine — and another brass chain around the base over the metallic coatino- of the other condenser, and to each chain an ordinary electrode, preferably a carbon electrode covered with leather, is at- tached. In the arrangement represented in Fig. 60 the corresponding knob on one side, and the hook communi- cating with the exterior coating on the other, are points with which connections may be readily and conveniently made. The discharging rods are placed at a distance apart which is determined by the effect to be accomplished, which consists in the faintest tingling when the rods are nearly together, or the most powerful muscular contractions when they are some distance apart. The same kind of irritation of the sensory nerves is caused by this interrupted current as that caused by the faradic, but it is softer. When the discharging rods are slightly separated, a weak muscular contraction is induced at every interruption. If the plate is made to revolve with the maximum speed, no distinct muscular contraction — only a faint vibration — is observed. When the sparks pass slowly and some distance apart, strong muscular contractions are induced with each inter- ruption. The most powerful contractions are caused with- out pain. In this respect static electricity possesses distinct advantages over faradic. Dr. Morton employs an inter- rupting handle electrode in his mode of using this current to produce muscular effects. Such an interruption is 156 ELECTRO-THERAPEUTICS. necessary, since the discharging rods are kept in oppo- sition ; but, used as I have above described, no special electrodes are necessary. Indeed, just so much of the current is taken as may be required, and the physiological effects correspond to the doses administered. Therapeutical Applications of Static Electricity. — Electrization by sparks has been applied with great success to the treatment of neuralgia. Sparks are drawn from the integument overlying the nerve. If the machine is power- ful and the nerve superficial, sparks can be drawn through the clothing, but this practice is more painful than when the sparks are drawn directly from the skin. The varieties of neuralgia thus treated are trifacial, cervico-occipital, in- tercostal, sciatic, etc. There is general agreement amongst those who have reported on the applications of statical electricity, that it is usually very effective in these forms of neuralgia. Amongst those who have used it successfully in the various forms of neuralma are Drosdow,' Stein, ^ Ischewsky,3 Benedictow,'' Vigouroux,^ abroad, and in this country, Morton, Rockwell, Stillman, Knight, Morgan, and others. In the treatment of these affections, the method of electrization by sparks may be used or the current tapped, as has been described. When the latter method is used, moistened electrodes are so applied as to include the seat of pain in the circuit, and a strength of current not suffi- cient to cause muscular contractions is employed. In the treatment of Jiysteria, statical electricity has achieved its greatest triumphs. In the severest examples of Jiystero-epilepsy it has succeeded in the hands of Charcot and his pupils, especially Vigouroux. Dr. Arthius^ has * Drosdow : Vratch as quoted by Virchow and Hirsch's Jahresbericht, 1883. ^ Stein : Ibid., 1882, vol. i. p. 45. ^ Ischewsky : Neurol. Centralblatt, No. 10, 1882. * Benedictow : Ibid., 1883, p. 525. 5 Bull. Gen. de Therap., 1883, p. 65. * L'Electricite Statique et L'Hysterie, Paris, 1881. APPLICATIONS OF STATIC ELECTRICITY. 157 made it clear that he was the pioneer in this movement, and that afterward the use of static electricity was taken up by Charcot. It is of little moment who initiated the practice, as compared with the important therapeutical re- sults which have been obtained by the use of this agent in all hysterical affections. A single sitting may sometimes remove apJiouia, a paralysis, a contracture, Jicviiancethesia, even hystero-cpi/cpsy, but, as a rule, the number of applica- tions has a certain ratio to the severity of the hysterical affections. General franklinization and electrization by sparks are the usual modes of application. Sparks should be drawn from the affected area or region. It is not only the French physicians who have found the best results from this treatment, but the conservative Germans also report facts strongly confirmatory of the French observations. Thus Erlenmeyer,' an eminent German neurologist, reports a case of hystero-epilepsy in which, after the failure of magnets, metals, and galvanization, statical electricity suc- ceeded perfectly. Benedictow,^ Ballet,^ Morton, and Black- wood, of this country, Stepanow^'' of Russia, and many other neurologists and electro-therapeutists, have reported ex- amples of complete and permanent relief afforded by this mode of electrical application in these functional disorders. In the treatment of the various forms of paralysis, when the muscles are in a condition to react to stimulation, and under the circumstances in which heretofore faradic appli- cations have been made, static electricity will be found preferable. The mode of arranging the instrument for muscular effects has been explained. The advantages possessed by this treatment are the efficiency of the con- tractions, and the painlessness of the applications. Slow ' Centralblatt fiir Neivenheilk, No. i, 1879. - Neurolog. Centralblatt, p. 525, 1883. •' Progres Medicale, Nos. 17 and 18, 1883. * Virchow und Hirsch's Jahresbericht, vol. i. p. 474, 1883. 158 ELECTRO-THERAPEUTICS. or rapid Interruptions are readily obtained, and the strength of current required does not give rise to any pain in the skin. In the various neuroses involving either the motor or sensory sphere, static electricity produces excellent results. In cJiorea, torticollis and histrionic spasm recent in origin, muscular contractures, etc.. o-ood effects are had from this remedy. In these affections the overacting muscles are quieted by a weak current very rapidly interrupted, and the paretic muscles are strengthened by pursuing the opposite mode. Static electricity, like faradism when applied generally, has distinct tonic effects, and in a higher degree than the latter. To procure the tonic and reconstituent effects, general franklinization should be employed, and sparks drawn from the organs of vegetative life — from the hepatic, splenic, umbilical, iliac, and thoracic regions, from along the spine and over the extremities. I have seen some cases of phthisis remarkably improved by this practice. It is surely deserving of more attention than it has hitherto received. CHAPTER III ELECTRO-THERAPEUTICS. Galvanism in Cerebral Diseases. — The passage of galvanic currents through the brain has been clearly established. As the superior ganglion of the cervical sym- pathetic exerts an immediate control on the cerebral circu- lation, and as it can be acted on by galvanic excitation, it is obvious that we possess in galvanism an agent which can influence the intracranial circulation, and the nutrition of ELECTRICITY IN CEREBRAL AFFECTIONS. 159 the intracranial organs. Without attempting to act directly on the ganglia of the cervical sympathetic, it has been repeatedly shown that transverse currents through the head apparently affect the intracranial circulation. There is a general belief that the particular direction taken by the current is of no moment. So long ago as 1861 Robin and Hiffelsheim had shown that galvanization of the sympa- thetic increased the activity of the capillary circulation. As we have already stated, Onimus and Legros confirm this view. On the other hand, there are those who maintain that current direction and polar action are of importance. Lowenfeld,' in his brochure on the electro-therapeutics of the brain, insists on the different effects due to the direction of the current. His ofeneral conclusion is that when the w^hole brain is to be galvanized the currents should pass in the sagittal direction ; and the entire duration of each ap- plication should not be longer than two minutes. Certain precautions are necessary in making galvanic applications to the brain. , Before applying the electrodes the operator should test the strength of the current on himself. Strong currents are never proper about the neck, face, and head, under ordinary circumstances. When an extreme degree of susceptibility exists, the applications should be made very cautiously, beginning with a fraction of a milliampere by means of the rheostat, and gradually increasing the strength if necessary-. Cerebral Congestion. — Excellent results are obtained in cerebral congestion by galvanism and faradism. Fre- quently interrupted galvanic applications are best adapted to this purpose. The positive electrode — anode — is placed in the fossa behind the angle of the jaw, and the cathode on the fifth, sixth, or seventh cervical vertebra, and inter- ruptions (anodal) are practised every few seconds. As ' Experiment, u. krit. Untersuch. zur Electro-therapie des Gehirnes. Miin- chen, 1881, pp. 146. Also, Centrabl. f. d. med. Wissenschaften, Xo. 8, 1881. 160 ELECTRO- THERAPEUTICS. in the opening and closing the circuit flashes of Hght and vertigo are experienced, caution must be exercised. Patients unacquainted with the sensations produced by galvanism are apt to disregard the lighter disturbances, and to demand something that can be strongly felt. They should, therefore, be instructed in the character of the effects to be produced. The interruptions should produce only the faintest possible flashes of light and the most tran- sient giddiness. The applications ought not to exceed three minutes — according to Lowenfeld, two minutes — in duration including interruptions, and should be made daily. If some improvement is not perceptible after a few applica- tions, no good will be accomplished by a repetition of them ; but if good results are obtained they ought to be contin- ued, with occasional intermissions, until recovery. Faradic applications may be made to the lower extremities as a derivative in cases of cerebral congestion. For five minutes the lep- and thieh muscles should be made to contract and the skin excited. The efiect of thws treatment is to increase the amount of blood in the lower extremities, and to raise their temperature, and consequently to lessen the amount passing to the intracranial organs. There are persons, however, who possess such an irritability of constitution, that faradic excitation of the members will cause a general increase of circulation and elevation of temperature. In such subjects faradization of the lower limbs should not be practised for the relief of the disease under consideration. Cerebral Auccinici. — It would seem paradoxical to assert that a remedy effective for cerebral hyperaemia should also be useful in cerebral anaemia, but very different results follow variations in the mode of applying the currents. In cerebral anaemia, as in the opposite states, only the feeblest currents are proper. The electrodes are applied on the forehead and nape of the neck, and on the mastoid process of each side. The applications should be labile, or inter- ELECTRICITY IN CEREBRAL AFFECTIONS. 161 rupted, and for not more than a minute in each direction. Applied in this way, the intracranial circulation is promoted, and the nutrition of the brain improved. No very striking results can be expected from a few applications, and when benefit is experienced it is gradual. If, after ten days of daily applications, no good whatever is apparent, it will be useless to continue them. When cerebral anaemia is a part of a general anaemia and not local, and when the anaemia is due to a depressed state of the assimilative functions, much benefit is derived from general faradization and central oralvanization — methods and conditions of which more will be said hereafter. In affections of the brain and cord char- acterized by peripheral anaesthesia, and in various chronic affections, hypersemia, and inflammatory conditions, Rumpf highly extols the method of general faradization, especially the faradic brush, which is applied to head, spine, and ex- tremities, but only a mild current used. Partial cerebral anaemia is a more important state as regards electrical treatment. Certain districts of the cere- brum — notably, the region supplied by the left middle cerebral artery — may be suddenly deprived of blood by embolic obstruction of a vessel. Often there will be asso- ciated disease of the left heart, especially of the mitral valve, right hemiplegia, and aphasia. Under these circum- stances embolic blocking of the left middle cerebral or one of its branches, has taken place with the phenomena of apoplexy. Such an accident occurs in young persons. In the aged, however, local cerebral anaemia is produced at various points in the brain by endarteritis, roughening of the intima, and coagulation of the blood closing the vessel finally as the obstructions encroach on the lumen. Not alone does anaemia follow in the area supplied by the ob- structed vessel, but if the artery be a terminal artery,'' ^ Deutsche med. Wochenschr., 32, 36, and 37, 1881. 2 Cohnheim, Untersuchungen ijber die Embolische Proces^cn. 11 162 ELECTRO-THERAPEUTICS. collateral hypersemia and oedema follow. Under diese circumstances is galvanism proper as soon as the imme- diate effects of " the stroke" pass off? We hold that it is. Much of the damage done in these cases is due to the collateral hyperaemia and oedema, for if such anastomoses existed as would enable the circulation to be carried on, the symptoms of local anaemia would soon disappear. To restrain the hypersemia and to promote absorption of the effusion, are the important objects to be accomplished by the use of galvanism. In similar hyperaemia and oedema of external parts, the good effects of the galvanic current in restoring tone to the distended vessels and in causing absorption of oedematous effusion are very conspicuous. Although it may be supposed that the quantity of electricity reaching the affected region is too small to be of any use, because the application of weak currents is held to be essential, yet it is certain that some good is done by them. Transverse and longitudinal currents should be transmitted through the cranium, beginning their application after the effects of the shock have subsided, produced by the sudden anaemia. In the case of thrombosis of the cerebral vessels, we have to deal with very different conditions. Instead of sudden blocking^ of a considerable vessel of the brain, and the resulting anaemia, there occur, owing to changes in the walls of the vessels, gradual occlusion by clots of small vessels, arterioles, and capillaries. The interference with the nutrition of the brain, which this widespread disease of the vessels involves, leads to serious disorders of function. As regards the mental condition, there ensue melancholia, senile dementia, and other forms of mental derangement ; but that state especially for which electrical treatment is so serviceable is the gradual failure of mental power, with the headache, vertiofo, and muscular feebleness associated with it under these circumstances. In another group of cases, ELECTRICITY IN CEREBRAL AFFECTIONS. 163 owing to atheromatous changes in the vessel walls, miliary aneurisms form, and such interference with the nutrition ot the brain is the result in many instances, that failure ot memory, of the power of attention, and of the mental faculties in general, and an emotional state occur. There can be no question of the great value of a weak galvanic current, slowly interrupted, in such cases, but the applica- tions should be kept up for some time. Dr. Lo>venfeld' has formulated the following conclusions regarding the action of galvanism on the brain : 1 he positive pole at the forehead, and the negative at the neck, determine a contraction of the arteries of the pia mater. When the position of the poles is reversed — that is, the anode at the neck, and the cathode at the forehead — dilatation of the arteries ensues. When the galvanic cur- rent is made to pass through the brain transversely, dilata- tion of the vessels occurs on the side of the anode, and contraction on the side of the cathode. Erb and other authorities deny the accuracy of these observations. The treatment of psychical disordej^s by electricity has been productive of some very striking results. The most important contributions to this subject have been made by Arndt,' Allbutt,^ Williams,^ and others. A high grade of psychical hyperaisthesia is regarded by Arndt as a con- traindication. This view coincides with the experience of Williams, who finds that the mania of bodily weakness is the particular field of usefulness of electricity. Arndt further points out that those cases are favorable to the action of this remedy in which the mental disturbance is due to vascular conditions. When stupor and insensibility ^ Experimentelle Biitiiire ziir Electrother. des Gehirns. Centralbl. f. d. med. Wissensch., No. 8. i88r. * Zeitschr. fur P^ychi.urie. Band 3+. S. 92. Zur Electrotherapie der psychischen Krankheiten. Also, Band 28. 3 West Riding Lunatic Asylum Reports, vol. ii. p. 303 et scq. * London Medical Record, vol. i. p. 413. 164 ELECTRO-THERAPEUTICS. are the object of treatment, then faradism, he holds, is the proper agent. The mode of appHcatlon which he advises consists in placing the anode over the central organs and the cathode at the periphery. Clifford Allbutt, of Leeds, has made some valuable, if not extended observations, at the West Riding Lunatic Asylum, on the effects of elec- tricity in various kinds of mental derangement. He con- cludes that galvanism does good in acute primary dementia — that "marked improvement took place " in these sub- jects. In " mania, atonic melancholia, and perhaps recent secondary dementia, distinct improvement was noted, but to a less degree than in primary dementia." "In chronic dementia, and in some cases of melancholia, no change was induced by the current, and it acted unfavorably in hypochondriacal melancholia, and perhaps brain wasting." Williams reports eleven cases in which electrical treat- ment was pursued, and in five of these the results were remarkably good. The kind of cases benefited were those mentioned above — cases of mental derangement due to depression and bodily weakness. Robertson' reports a case of insanity of seven years duration, cured by galvan- ism, applied to the head and to the cervical sympathetic. The result of the experience with electrical treatment in the Vienna general hospital,^ by Benedict,^ Letourneau,* and others, is quite in accord with that just narrated. The improvement was most marked in the cases of slight psychic disturbance occurring in anai^mic subjects. The testimony from widely separated and independent sources seems conclusive of the value of galvanization in cases of mental disorder due to or accompanied by the evidences of bodily depression. It is probable that the curative in- ' The Journal of Mental Science, April, 1884. ' Wiener med. Presse, Nos. 14, 17, and 19, 1874. ' Wiener med. Blat, No. 35, 1885. * Gazette des Hopitaux, No. 119, 1878. ELECTRICITY IN CEREBRAL AFFECTIONS. 165 fluence of the electrical current is due mainly to the excitation of the intracranial circulation. It has been pointed out in the physiological section that galvanization of the vasomotor system stimulates the vermicular motion of the arterioles, and thus promotes the circulation through the parts acted on. Arndt suggests peripheral faradization as a means of stimulating the intracranial cir- culation. There can be no doubt, how- ever, that galvanization is the proper kind of electrical stimulation. The mode of application in these mental disorders is as follows : Well-moistened electrodes are placed on the forehead and nape of the neck, and on the mas- toids, so as to transmit transverse cur- rents ; the superior ganglion of the cervical sympathetic is included within the circuit by placing one pole (the anode) in the fossa behind the angle of the jaw, and the other pole on the neck, about the vertebra prominens ; and central galvanization is practised by placing the negative pole on the epi- gastrium, and the positive in turn, over the pneumogas- trics, the cervical and dorsal spine, etc. For the fossa behind the angle of the jaw, electrodes c and d are suita- ble shapes, and b and a for the neck and epigastrium (Fig. 6i). Electrodes, arranged to screw on handles, which are not shown. 166 ELECTRO-THERAPEUTICS. CHAPTER IV. ELECTRICITY IN SPASM AND CRAMP. In the medulla oblongata and the spinal cord are situ- ated the centres concerned in spasm. In the medulla is placed by Nothnagel his "spasm centre," and above this organ is the inhibiting centre of reflex movements (Sets- chenow's). No fact in regard to galvanism is more con- spicuous than its power to allay spasm. When a strong current is passed through a muscle, it remains perfectly quiescent and relaxed until the current is broken. The irritability of motor nerve and of muscle is allayed by galvanism. From the theoretical standpoint, it is the descending current which possesses this property, but in practice it is found that the direction of the current is of little importance. Galvanism diminishes irritability and faradism increases it, and they are applicable accordingly. Galvanism has been used with variable but not striking results in the treatment of epilepsy, by Gumplowiez and Klotzbsrg,' I\ockwell,' Arndt, Allbutt, and others. The experience with this treatment has developed certain facts: I St, it is adapted to the cases of essential epilepsy, and is without influence over symptomatic epilepsy, or epileptiform seizures ; 2d, it is admissible in the cases characterized by anaemia and depression of the vital forces, and is not useful in the conditions of plethora. The best results have been obtained by Rockwell, and by Althaus,'' but it does not appear that curative effects have ever been observed. Rockwell employed the method ' Wiener Presse, op. cit. 2 Njw York Medical Record, April 3, 1878. ' Medical Electricily, op. cit. ELECTRICITY IN SPASM AND CRAMP. 167 known as "central galvanization." Severe cases of chorea sometimes yield very promptly to galvanization of the spine and of the sympathetic — an example of which is related by Leube.' This treatment has also been success- ful in the hands of Benedict, who, in addition to spinal and sympathetic galvanic applications, faradizes the volun- tary muscles generally. Under this treatment of com- bined galvanism and faradism, cures are effected in a short time (Althaus). Static electricity was long ago success- fully used in the treatment of chorea by Dr. Addison ; afterward by Golding-Bird and Gull, and more recently by Vigouroux, Hammond, Benedictow,^ and others. Frank- linization (patient on an insulated stool), electrization by sparks drawn from the spine and muscles, and the several forms of electric bath have lately been very successful. The magnet, as has been shown in the chapter on that sub- ject, sometimes is surprisingly effective, but more often fails. The good effects of the electrical treatment are due to the improved activity of the circulation in the nervous centres, and to the tonic effects of the faradic applica- tions on the muscles. With the electrical may be com- bined the usual medicinal and hygienic methods of treat- ment. Local cJiorca, as histrionic spasm, nystagimis, etc., is sometimes promptly cured by galvanic or faradic appli- cations. When histrionic spasm is of long standing, it is most rebellious to all kinds of treatment, but, if at an early period the irritability of the affected muscles is allayed by galvanism, a cure may be effected. The most promis- ing method consists in the application of a stabile current, the anode resting on the disordered muscles. The seventh nerve should also receive stabile applications, and the sympathetic ganglia of the corresponding side should also ^ Berliner klinische Wochenschrift, No. 35, 1874. » Neurol. Centralblat, 1883, from Vratch. 168 ELECTRO -THERAPEUTICS. be stimulated. All sources of reflex irritation must be removed. Time is as important as respects the curability of nystagmus as of histrionic spasm. Recent cases, not due to intracranial lesions, and purely local in origin, although reflex influences may have excited the muscular disorder, are the most favorable. Cases of nystagnms, acquisitiLS ociili, and of the periodical form, have been cured by Soethin' and Nieden,^ by galvanism, the anode resting on the mastoid process and the cathode on the eyelid. Blephai^ospasm has been relieved by stabile applications, and the accompanying pain and inflammation also. So much, however, depends on the cause of the reflex spasm that the best results are obtained when the exciting irrita- tion has been removed, the muscle persisting in spasm. A well-moistened sponge electrode — the anode — should rest on the affected muscle, the eye being closed, and the cathode on the cheek below. The current should rise slowly to the maximum, and should be only strong enough to produce faint flashes of light, and should decline with- out shock. Torticollis, or nuy-neck, is compounded of spasm and paresis, but the element of spasm so far preponderates that it is best considered in this connection. The affection has its real seat in the spinal accessory nerve, or in those motor filaments which innervate the sterno-cleido-mastoid and trapezius muscles. The evidence of irritation of a motor nerve trunk is spasm of the muscles to which the nerve is distributed. The spasm may be in the sterno- cleido-mastoid, or in the trapezius, and the head will de- viate from its usual, and be fixed in the abnormal position accordingly. The affected muscles are tense, painful, and rigid. The antagonistic muscle are weak and relaxed. 1 Wiener med. Presse, No. 47, 1873. ^ Berliner klinische Wochenschrift, No. 47, 1874. ELECTRICITY IN SPASM AND CRAMP. 169 The object of treatment should be to relax the spasm of one set of muscles, and to strengthen the other set. A stabile galvanic current accomplishes the first object when applied to the tense and contracting muscles, and a faradic current effects the second object by stimulating the weak muscles on the other side. It is important to note that strong currents are required in the treatment of these cases. I have usually employed thirty to forty of the elements of Siemens and Halske, and a faradic current of sufificient intensity to throw the weak muscles into very active contractions. The applications should be made daily, and the sittings may be ten minutes — five being occupied with each application. In several instances, when the spasm was in the trapezius, I have seen the head very rapidly straightened by a strong galvanic current interrupted every half minute. In my experience, a cure is readily effected in recent cases of torticolHs, when there are no lesions of the spinal cord, or of the vertebra, or of the nerve trunk. Moritz Meyer' reports a case cured after a year. Spasmodic stricture of the (Esophagus is usually readily cured by galvanism. Dr. F. F. Frank^ narrates a case in which a cure of this disease was effected by direct applica- tion to the oesophagus, the cathode resting at the stricture. Singidtiis or hiccongJi is often promptly arrested by both currents. The action of the currents is, however, not the same. When galvanism is used, a descending stabile cur- rent is passed through the phrenic, the anode being placed over the nerve above the clavicle, and the cathode at the epigastrium. The current is also transmitted transversely through the body so as to include the diaphragm in the circuit. When faradism is used, the principle of inhibi- tion of action is called into exercise. At the moment the ^ Deutsches med. Wochenschrift, No. i8, 1875. ^ Archives of Electrology and Neurology, vol. ii. p. 23, May, 1875. 170 ELECTRO-THERAPEUTICS. spasm is to occur, a strong faradic current is transmitted through the walls of the chest ; both impressions arriving at the spinal centre at the same moment, one inhibits the other, and an arrest of action is the result. I have thus succeeded at once in arresting hiccough when the galvanic current had been used for hours with but partial relief. Spasmodic asthma is sometimes remarkably improved by galvanism of the pneumogastric nerves. NefteP reports successful cases, and I have seen very great improvement. Dr. P. Eade' reports a case of asthma cured by the pri- mary induced current after the failure of various remedies. He applied one pole behind the angle of the jaw, the other over the sterno-mastoid. lilectricity is, of course, adapted to the cases of spasmodic asthma without complications. If such a case is treated during the existence of the par- oxysm, by galvanization of the pneumogastric nerve, the difficulty of breathing soon subsides. If the irritability of the end organs of the vagi be relieved by systematic gal- vanization in the intervals between the seizures, and more frequent applications with the first warnings of an attack, results of a permanent character may sometimes be achieved. The dilticulty of breathing occurring parox- ysmally in emphysema is sometimes much improved by galvanization. The benefit derived from galvanism is the more obvious, the more the attacks are nervous, and the local condition that of spasm. Galvanism is one of the numerous remedies employed against tetanus. The dictum of Onimus and Legros, that there does not exist in science up to the present a single example of cure of tetanus by means of the electrical current, cannot be accepted without qualification. These authors, however, give full details of a case of tetanus cured by the combined administration of chloral and elec- ' GalvanotherapeiUics, 1871, p. 161. ' The British Medical Journal. ELECTRICITY IN SPASM AND CRAMP. 171 tricity. and which demonstrates the character and degree of the utility of electrical treatment. It was found that during the passage of the current, the contracted muscles were relaxed, to the great comfort of the patient. Chloral calms, produces sleep, but does not relax the contracted muscles. The current is also useful to prevent the fixation of the muscles of respiration and death by asphyxia. 1 he appli- cations should consist of the descending current to the spine and to the extensor muscles, of medium intensity, and of a duration not greater than an hour or two at a time. The good effects of this mixed method of treatment are sufficient to justify further trials : the same method might possibly prove useful in hydrophobia. Dr. Mendel,' of Berlin, reports two cases of tetanus, one of the trau- matic, the other of the idiopathic variety, cured by galvani- zation. In the first case, eight cells (Daniell's) were used, the positive pole to the forearm, and the negative to the cervical spine ; and in the inferior extremities, the positive pole to the anterior part of the leg and the negative to the lumbar spine. Fifteen minutes was the duration of the applications. In the other case, a cure was effected within ten days by the same mode of application. Dr. Mendel advises a mild current to the affected muscles, the positive pole acting on their antagonists. The effect seems to be due to the influence of the current on the sensory nerves, thus lessening the intensity of the reflexes. Strong cur- rents seem to be less effective than mild, a fact to be borne in mind, since, owing to the violence of the disease, the temptation exists for the use of strong measures. Writer s cramp, and allied defects, from overuse of cer- tain muscles, are more successfully treated by galvanism than by any other means. With galvanism must be con- joined rest and systematic gymnastic training. Indeed, ' Berliner klinische Wochenschrift, September, iS68. 172 ELECTRO-THERAPEUTICS. without rest "no improvement can take place in the condition of the affected muscles. The state of the muscles in writer's cramp varies in different cases. There may be a cramp of the muscles concerned in the prehension of the pen ; there may be a condition of fatigue and exhaustion, or some of the muscles may be paretic. Some of the cases are local and muscular ; some are local and nervous, and a small proportion have their orig-in in intracranial lesions — in changes in the motor and coordinating centres. It is ob- vious that the treatment must be adapted to the conditions present. As most of the cases are due to muscular fatigue and cramp, the most appropriate remedy is galvanism, but this must be conjoined with rest, massage, and gymnastics. The anode should be placed over the cervical plexus, and the cathode brushed over the muscular groups in turn from the shoulder down. If the defect is confined to the thumb and finger muscles — to the thenar group, the interossei, and flexors of the fingers — the applications should rather be confined to these parts, and consist in the descending labile current. If the lesion consist in relaxation, paresis, and degeneration of any of the muscles, faradism may then be employed with advantage. Duchenne's electrodes are best adapted to cases requiring application to individual muscles. The affected muscles must be selected out, and a current of a strength necessary to induce contractions, merely, passed through them. Under no circumstances ought the muscles to be tired, either by the strength or duration of the applications. Statical electricity used in the mode already indicated for causing muscular contractions, is an equally effective agent for restoring the paretic mus- cles, and is at the same time less painful and less apt to induce fatigue. Treated in accordance with these principles, recent cases of writer's cramp may be cured or ameliorated. ELECTRICITY IN THE PARALYSES. 173 CHAPTER Y. ELECTRICITY IN THE PARALYSES. The paralyses are referable to one of three groups : to the cerebral, due to disease of the cerebral organs ; to the spinal, due to disease of the pons, medulla, or the spinal cord, below ; to disease or injury of the peripheral nerves. These anatomical distinctions are not only correct in the anatomical sense, but, also, from the diagnostic and thera- peutical point of view. The cerebral paralyses have been sufficiently discussed. The spinal paralyses include the results of inflammation of the mening-es and of the cord, and chronic affections — as infantile paralysis, progressive muscular atrophy, and others. For the purposes of elec- trical treatment the spinal paralyses may be divided into those with, and those without, loss of faradic excitability, or the reactions of degeneration. Again, some of the paral- yses are characterized by rapid wasting of the muscular tissue, and others equally by its preservation. The diagnostic applications of electricity have been suffi- ciently set forth ; but the reader should bear in mind that the power of the muscles to react to a faradic current is lost in cases of spinal disease when that part of the spinal cord is affected from which the muscles are innervated. When in cases of paraplegia the muscles do not respond to a faradic current, but do respond to a slowly interrupted galvanic current, the disease is situated in that part of the cord supplying the lower extremities with innervation. Spinal Paralyses. In paraplegia caused by an acute inflammation of the spinal meninges or cord, the electrical treatment should be 174 ELECTRO-THERAPEUTICS. postponed until all acute symptoms have subsided. Appli- cations must be made to the spine and to the affected muscles. As the objects of the treatment are to remove the products of inflammation, and to improve the nutrition of the cord, a galvanic current should be transmitted through the cord. As- the resistance is great, a current of considerable intensity is necessary. A descending stabile current from thirty, forty, or more elements — 20 to 40 milliamperes — should be passed, the positive pole of large size, well moistened, on the neck just under the occiput, and the negative on the sacrum. If any specially tender points exist on the spine, the positive should be placed on these also. The spinal nerve roots, having an intimate rela- tion to the lesions, ought, also, to be included in the circuit by lateral application of the cathode to each side, taking each nerve in turn, the anode resting on its point of origin. Paralysis of the bladder and rectum, when present, adds materially to the discomfort and increases the peril of the patient ; hence it is highly important to restore the func- tional condition of these organs. I have succeeded, in cases otherwise not amenable to treatment, in restoring control of the bladder and rectum. An effort ought always be made to accomplish this, for a paraplegic, having at the same time incontinence of urine and feces, is not only more liable to bedsores, but he is an object of disgust to all about him, and is, therefore, likely to be neglected. I have succeeded often with the faradic current, by placing an electrode on the spine, and the other, properly insulated and termi- nating in a metallic button, in the rectum and bladder. A properly interrupted galvanic current will accomplish the same purpose. Beside the applications to the spine, the paralyzed muscles should receive attention. If the muscles of the paralyzed members have not wasted, and react in the normal manner, or more readily to the faradic current, their condition cannot be improved by electricity. In cases ELECTRICITY IN THE PARALYSES. 175 of disseminated disease, there may be groups of muscles reacting in a perfectly normal manner, and other groups that do not react at all to a faradic current, but with abnormal readiness to a galvanic current. Whilst the former do not, the latter do require electrical treatment. It follows from this fact that in cases of paralysis from spinal disease, the muscles should be carefully examined as to their electro-contractility. Although in inflammatory affections of the spinal me- ninges or cord electrical applications are not proper until the acute symptoms have subsided, the same rule is not necessarily binding in respect to the treatment of the muscles. When the tendency to wasting and degenera- tion of the muscular elements manifests itself, the more promptly the electrical treatment is undertaken, the better. If the muscles do not react to faradism, a galvanic current should be employed, and the muscles exercised with this, until the power of response to the former is restored. A current of sufficient strength merely to cause muscular contraction only is necessary. Pains and hyperaesthesia are removed by galvanism ; anaesthesia by the faradic brush. Notwithstanding the rule to avoid the treatment of acute affections of the cord by electricity, Hitzig' reports a case in which striking results were obtained by galvanization of the spine, of the principal nerve trunks, and of the sympathetic, the applications to the spine being both labile and stable. Levin reports a similar success. Beginning the treatment on the twentieth day after the onset of symptoms, remarkable improvement resulted from the galvanic applications. In respect to chiwiic myelitis, there can be no question in regard to the value of electrical treatment. The appli- cations must be made to the spine by large electrodes, the ' Virchow's Archiv, Bind xl. S. 455. Zuy Puthologie und Thrrapie ent- zundliches Ru^kenmarks AJjfeciionen, von Dr. Edward Hitzig in Berlin. 176 ELECTRO-THERAPEUTICS. current from 20, 30, 40, even more of the large elements of Siemens and Halske, or of Hill — 20 to 40 milliamperes — being necessary to reach the cord. There are two modes in which the cord or affected areas can be reached: by a reflex impression ; by a direct excitation. When the surface is mildly irritated, the vessels of the cord change in calibre — probably contract — and the cells in which the peripheral sensory fibres terminate undergo some mole- cular modification. To this kind of action may be referred the effects of cutaneous irritation of mild faradic and galvanic currents. The cord may, however, be acted on directly. I here is a singular misconception as to the strength of current necessary to do this. The resistance offered by the soft coverings and the bony envelope is very great, and hence very high electro-motive force is necessary to overcome it. From 20 to 30 milliamperes, or from 30 to 50 elements, will be required to reach and act on the cord efficiently. As the application of this current-strength by carbon elec- trodes covered with leather produces intolerable burning, the electrodes used for this purpose should be of large size and covered with sponge. The larger the surface at which a given quantity of galvanism enters the skin, the less painful the application. The position of the elec- trodes will be determined by the seat and character of the lesions. If circumscribed, the poles must be placed near each other ; and if the longitudinal area of the cord is involved, one pole should be placed on the nape of the neck and the other on the sacrum. There are decided differences of opinion as to the effects of the poles and of the current direction. Ominus and Legros maintain that a descending current increases the blood supply, and that an ascending current lessens it ; but the opposite view is held by the majority of those who advocate polar applications. The fact is, probably, as Erb maintains, that the direction ELECTRICITY IN THE PARALYSES. 177 of the current has but little influence, and that both poles had better be applied to secure the catalytic effects of both. If there are tender points on the cord, it is good practice to apply the anode to them and the cathode elsewhere, usually on the epigastrium. Besides the direct application to the cord, the ganglia of the sympathetic are stimulated to Influence the vaso-motor and trophic centres. This purpose is accomplished by the method known as '* central galvanization." The cathode is put on the epigastrium and the anode is placed successively on the top of the head, on the neck, over the sympathetic ganglia, and on the cervical vertebra, and finally on the dorsal vertebra opposite the epigastrium, the number of milliamperes used varying with the intensity of the action in each position. The duration of the application In chronic myelitis will range from five to fifteen minutes, and the frequency will be determined by the character of the case. 1 am con- vinced that in many cases much more permanent and assured results would be obtained by more frequent appli- cations. When the interval is too long, the impression made by one application has ceased before the next begins ; they are usually daily, and may often be twice a day with advantage. The whole duration of the electrical treatment must necessarily be very uncertain. To avoid injury by too long, continuous applications, they should be intermitted occasionally. The seances should not be lono-er than a minute or two for the spinal application, but the peripheral nerves must be stimulated also, and the muscles exercised, so that ten minutes or more may be occupied. The treatment of the paralyzed rectum and bladder, by intra-vesical and rectal electrodes, as already mentioned, is an important part of the electrical method. The relief to the pain, tingling, and unrest, in the paralyzed members, is best afforded by stabile and labile galvanic currents, the anode on the spine and on 12 178 ELECTRO-THERAPEUTICS. painful spots, and the cathode resting on the peripheral nerves, or brushed over the whole of both members. Cold- ness, bluish discoloration, dry and scaly skin, and anaesthesia are best relieved by the faradic brush, applied in turn over all of the paralyzed parts. The paralyzed muscles must be treated, as already laid down, by the faradic current, if they respond to it ; if not by the galvanic, which is to be contin- ued until the faradic acts. There are now no differences of opinion as to the utility of electricity in chronic myelitis. I have myself seen the most striking results. Erb' reports that of one hundred cases treated by it, he obtained a more or less favorable result in fifty-two. Rosenthal' speaks in high praise of the good effects of electricity in the paralysis of the bladder and rectum in myelitis. His preference is for an interrupted galvanic current, one electrode placed in the rectum, the other on the hypogastrium. Erb holds that the treatment must be continued for months, and, if necessary, interrupted for a time, to be resumed again. Infantile paralysis is a typical example of a spinal paral- ysis, and affords the best evidence, probably, of the good effects produced by electricity. This disease is usually re- garded as an affection of the anterior cornua of the spinal cord, the multipolar ganglion cells being also involved. ^ In addition to their motor funcdon, these cells have an impor- tant relation to the funcdon of nutridon, and are regarded as "trophic." Besides the paralysis resulting from disease in this part of the spinal cord, the paralyzed muscles waste rapidly, and deformides result in the limbs, spine, and joints. The atrophic degeneradon of the muscles begins in a short time, and is very evident in a few weeks. To such an extent is the wasting carried that the muscles ' Ziemssen's Cyclopaedia, vol. xiii. 2 Klinik der Nervenkrankheiten, etc., von. M. Rosenthal. Stuttgart, 1875, p. 312. ' Charcot et Jofifroy : Archives de Physiologic normale et path., 1870. ELECTRICITY IN THE PARALYSES. 179 entirely disappear, and the skin rests on the bones. Less frequently the place occupied by the muscles is enlarged by fat and connective tissue, thus presenting an appearance of apparent hypertrophy — whence the name "pseudo- hypertrophic" (Fig. 62). In this disease the reactions of Fig. 62. Pseudo-hypertrophic infantile paralysis. degeneration are perfectly characteristic. As Duchenne' first pointed out, in this disease the reaction of the paral- yzed muscles to the faradic current declines quickly, and is entirely lost by the end of the second week in those mus- cles severely paralyzed. On the other hand, muscles whose faradic excitability merely diminishes, but does not entirely disappear, regain their contractility to the stimulus of the will, and the more promptly, the less the faradic ' De r Electrisation localisee et de son Applications a la Pathologie et a la Therapeutique. Deux, edition, Paris, 1861, p. 177. 180 ELECTRO-THERAPEUTICS. excitability has declined. Whilst the faradic excitability declines, the muscles manifest an increased readiness of response to galvanism, and contract energetically to a strength of current barely sufficient to move the healthy Fig. 63. Fig. 64. rrrr- ^ J) Fatty degeneration of the muscles. muscles. This fact, first demonstrated by Hammond, and nearly simultaneously by Radcliffe, was, it is alleged, some- what earlier ascertained by Salomon' (1868). The reflexes Fig. 65. Fatty degeneration of the muscles. are extinguished in this disease, but the sensibility of the skin is not impaired. The rectum and bladder continue to functionate normally. The electrical treatment consists in ^spinal and muscular ^ Jahresbericht d. Kinderkrankheiten, vol. i. li Quoted by Erb. ELECTRICITV IN THE PARALYSES. 181 applications, and the earlier it is undertaken after the termination of the fever, the better for the future of the patient. Old cases have proved so rebellious to the treat- ment as to cast discredit on the electrical method. To the spine large sponge-covered electrodes are applied, so as to Fig. 66. Fatty degeneration of the muscular elements in infantile paralysis. include the diseased area, and by the stabile method. The affected muscles, responding to the galvanic current only, must be acted on by this current until the power of reac- tion to faradism is restored. Each muscle must, in turn, be made to contract several times at each sitting, but fatigue must be avoided. Placing the anode over the spine, at a point corresponding with the highest level of the disease, the cathode is passed over the affected muscles in turn below, making each one contract several times. When the contractility to faradic stimulation is restored, the electrodes of the faradic battery are applied to the muscles by the direct or indirect method, until the reac- tions become normal. It cannot be too strongly insisted on, that the treatment of this disease demands the utmost patience and the most protracted perseverance. Unless the parents, and the patient, consent to give the necessary time* and attention to the treatment, it were better not to undertake it. Many months, even a year or two, may be 182 ELECTRO-THERAPEUTICS. required. Cases of long standing, in which deformities have occurred, are hopeless. When the muscles are simply wasted, the case otherwise being favorable, a cure may be expected by sufficiently extended treatment, provided there is still muscular tissue to react to the galvanic current. There can be no doubt as to the value of electrical treat- ment in suitable cases. With faradism alone, Duchenne^ was able to effect a cure in a considerable proportion of cases — of those in which the faradic excitability was less- ened, but not entirely wanting. Faradism could hardly be beneficial in cases so far damaged that the muscles cannot be made to contract by the strongest current. Onimus and Legros^ strongly condemn the faradic applications, and insist on the superiority of galvanism. They hold that the good effects are not due to muscular contractions, but to the influence of the galvanism over the circulation, and secondarily over nutrition, and over the trophic system. They make applications to the cord and to the peripheral nerves. The anode rests on the spine just above the seat of the lesions, and the cathode on the trajectory of the nerves passing to the paralyzed muscles, " maintaining on the cord, without interruption, during three to five minutes, a descending current from ten to twenty elements." The muscles are also acted on directly by labile applications. The whole duration of each seance is twenty to twenty-five minutes, and it should be held three to four times a week, for many weeks, intermitted occasionally, to be resumed again. In recent cases, Onimus and Legros say that " re- markable results" are obtained by their method. English authorities are equally positive as to the good effects of electricity in infantile paralysis. Thus Reynolds^ expresses himself in the treatment: "that, in all cases, the electrical * De I'Electrisation localisee, op. cit. " Traite d'Electricite medicale, op. cit., p. 490. ' A System of Medicine. H. C. Lea's Son & Co., 1879, ^''^^- '''• P- ioo7- ELECTRICITY IN THE PARALYSES. 183 and gymnastical parts of the treatment are of primary rather than of merely secondary importance, I am every day more and more convinced, because every day I meet with instances of muscles, which I should have once looked upon as hopelessly paralyzed, being resuscitated by those means." The German authorities, also, maintain the su- periority and success of the electrical treatment (Benedict,' Ziemssen,^ Eulenburg,^ and others). Progressive ?nuscular atrophy, which presents many points of analogy to infantile paralysis, differs from the latter in respect to the curative power of electricity. The actual seat of the primary anatomical changes is much disputed. There are two principal theories and a minor theory. The first and most authoritative theory is that the initial lesion is situated in the anterior cornua, especially affecting the multipolar ganglion cells, which undergo atrophic degener- ation and disappear. As a result of this lesion, and as we have found is the case in infantile paralysis, the muscles innervated from a diseased part of the cord waste, and ultimately their proper anatomical elements disappear. Cruveilhier* was the first to give a correct account of the grosser anatomical changes, but the first really accurate studies of the microscopical lesions in the cord were made by Charcot and Joffroy,^ and Lockhart Clarke.^ These studies demonstrated the constancy of the alterations in the anterior cornua of the spinal cord, and especially in the multipolar ganglion cells. These cells, as has been already mentioned, are concerned in the maintenance of ' Electrotherapie (erste Halfte, 1874), Wien, 1868. ^ Die Electricitat in der Medicin. ^ Lehrbuch der functionellen Nervenkrankheiten, etc., Berlin, 187 1, pp. 607 and 620. * Arch. General. Med., Mai, 1853, p. 561, and Janv. 1856, p. i. * Archives de Physiologic normale et pathologique, Paris, 1869, vol. 11, P- 356. ® Medico Chirurgical Trans., vol. 51, p. 249. 184 ELECTRO-THERAPEUTICS. the nutrition of parts with which they are anatomically connected. When these cells undergo wasting and disin- tegrate, the nutrition of the muscles declines and they ultimately entirely disappear. In cases of paralysis to an equal degree from disease of other parts of the cord, the muscles do not undergo atrophic changes to anything like the same extent. The next most important theory locates the initial changres in the muscles. From the affected mus- cular elements, the disease extends to the intra-muscular nerves. Thence by an ascending neuritis the cord is ulti- mately reached. The most recent and powerful advocate of this view is Friedreich.^ The least influential theory is that which regards the sympathetic system as the seat of the primary changes. The advocates of this view are Schnee- vogt^ and Eulenburg and Landois," chiefly. Which theory, soever, we may adopt, it is obvious that electricity must be applied both to the spinal cord and to the muscles, for both in cases well advanced are diseased. To the cord descend- ing stabile currents should be applied, and from the cord outwardly along the trajectory of the nerve trunks supply- ing the affected muscles. Faradic and galvanic applica- tions to the wasting muscles are of great importance. Hitherto electrical treatment has produced no results in progressive muscular atrophy. As sanguine as Duchenne is in regard to the curative powers of localized faradic applications, he frankly confesses their inutility in this malady. More recently much more favorable results have followed the systematic and persevering use of the galvanic current applied to the cord, to the muscles, and to the sympathetic by the method known as central galvanization. ^ Ueber progressive Muskelatrophie, etc., von Dr. N. Friedreich, Berlin, 1873- ^ Quoted by Friedreich. Supra. ^ Die vasomotorischen Neurosen. Wiener med. Wochenschrift, 1867 u. 1868. Separatabdruck, also. ELECTRICITY IN THE PARALYSES. 185 A case of advanced muscular atrophy has been reported cured by central galvanization alone, in the hands of Nesemann/ Good effects have been reported by Bene- dict,^ Erb,3 and others, by the combined treatment above mentioned. I have seen one case apparently entirely arrested and the wasted muscles in part restored by the persistent use of strong galvanic and faradic applications in alternation. When the muscles cease to respond to a faradic current, the galvanic must be used, and of sufficient strength to develop reactions. In all cases, the galvanic should be used in alternation with the faradic current, because of its greater influence over the functions of nutrition. I include in one group the scleroses of the cord, multiple sclerosis, anter^o-latei^al, and posterior spinal sclerosis (pro- gressive locomotor ataxia). Although these are not strictly paralyses, they are accompanied by more or less paresis, by incoordination of muscular movements, an apparent paralysis, and the principles and plans of electrical treat- ment are the same as in the group of paralyses. The electrical applications, in accordance with the fundamental principles, are made to the spine and to the peripheral nerves. Both forms of currents are used. A descendinof stabile current from twenty to forty elements is made to the spine daily, and labile applications from ten to twenty elements are directed to the painful points. For the anaesthesia of the feet and limbs, the faradic brush is most serviceable. I have seen excellent results in posterior spinal sclerosis from the persistent use of mild, rapidly interrupted faradic applications to the spine and limbs daily for a few minutes, but no cures, only amelioration. ^ Quoted by Eulenburg, Ziemssen's Cyclopaedia, vol. 14, p. 150. ^ Electrotherapie, op. cit. ' Quoted by Friedreich. Supra. 186 ELECTRO-THERAPEUTICS. Rumpf,^ of Dusseldorf, has recently had remarkable results from the persistent use of the faradic brush. He gives the details of a case which was arrested in the second staee, the man returning to work, but the "knee-jerk" continued absent. He reports other cases equally successful, but he is awaiting the results of time. The method consists in brushing with the wire-brush over the spine, thighs, and limbs for several minutes daily, using a current of moderate strength. Before applying the brush, the skin must be dried well. The application must be thorough and perse- vering, and its duration about fifteen minutes daily. The mechanism must consist in the reflex action. Rumpf has found that faradic brush stimulation of one side will cause an elevation of temperature of the opposite corresponding side. It is probable that the peripheral stimulation pro- motes the nutrition of the cord. Symptomatic treatment is very serviceable. The diplopia, incontinence of urine and feces, and pains may be very much relieved by faradic and galvanic application. Since Rumpf's paper appeared, various reports (Niemeyer,^ and others) have been made, the general result being that this method is very useful. In progressive locomotor ataxia, more favorable results are attainable by rest, hydrotherapy, and galvanism, than by any other means ; and of these, galvanism is the most important, unless Rurapf's plan of the faradic brush, gen- erally applied as before described, shall prove more effi- cient. The patient applying for treatment should be informed of the probable duration of the case, and the necessity for protracted applications extending over years. In some rare cases, electricity aggravates all the symptoms; when this occurs it should not be persevered in. It some- times happens that very mild currents do better; again, ^ Neurologisches Centralblatt, Nos. i and 2, 1882. '' Ibid., p. 353, for 1884. ELECTRICITY IN THE PARALYSES. 187 the strongest currents are most serviceable. The applica- tions should be modified accordingly. Peripheral Paralyses. Peripheral paralyses take their name from the situation of the lesions in the peripheral motor nerves. They con- sist of the so-called rheumatic inflammation, of neuritis, whether idiopathic or secondary, and of cases of traumatic injury to the nerve. The diagnostic relations of the sub- ject have been fully considered elsewhere ; we have now, therefore, the therapeutical questions for solution. The type of a rheumatic paralysis is that form of facial paralysis due to the impression of cold on the facial nerve Fig. 67. The muscles innervated from the seventh nerve — the facial — stimulated by a faradic current. — the seventh — after its emergence from the foramen, and where its ramifications form the pes aiiserinns (Fig. 6^]^. A current of cold air directed against the side of the face induces such a refrigeration of the nerve as to impair its 188 ELECTRO-THERAPEUTICS. conductivity. Paralysis suddenly ensues in all the muscles innervated by the nerve — the muscles of expression and that side of the face are blank and motionless, the naso-labial fold is obliterated, the eye cannot be closed : and hence, whilst the sound side exhibits all the varied and individual expressions of the human countenance, the affected side is utterly without the power of expression. This condition may be slight and exist for a few days, or it may be severe and continue for months and years. A small proportion manifest a tendency to spontaneous cure — the paralytic symptoms gradually declining without treatment, but an abnormal tardiness to react to the various emotions and feelings is apt to remain. If the case is a severe one, the muscles presently exhibit the reactions of degenera- tion — do not respond to a faradic, but do respond with abnormal readiness to a oralvanic current. In the mildest cases the reaction to faradism may be simply diminished and not wholly lost. In those cases arising from the impression of cold, some effusion probably takes place in the sheath of the nerve. Hence the best results may be expected to follow the application of galvanism. A descending stabile current may be applied, the anode rest- ing on the pes anscrimis, and the cathode on the peripheral portions of the nerve. Ten to twenty elements suffice. When the muscles are to be acted on, after a few days, labile currents are applied by small olive-shaped electrodes, each one or each group in turn receiving attention. The stabile galvanic applications can be made at once, the object being to cause absorption of the effusion, but excita- tion of the muscles should be postponed for a few days. As a very weak galvanic current slowly interrupted induces ready response on the part of the paralyzed mus- cles, it is unnecessary to employ a strong current. The muscles should be exercised daily for a few minutes at a time, but not long enough to induce fatigue. Many of the cases recover in a few weeks ; some require months, even ELECTRICITY IN THE PARALYSES. 189 years, of treatment. I have seen obstinate cases cured after two years of faithful electrical treatment. Cases of many years' standing have been cured by persistent appli- cations. After a more or less protracted treatment by galvanism, the power of response to faradic stimulation is restored, when this can be employed to complete the cure. Recently Dr. Ballet' has reported cures of facial paral- ysis by static electricity — by general franklinization and drawing sparks from the area of distribution of the seventh. The interrupted current of static electricity is an efficient substitute for faradism when it is desired to act on the muscles, as has been, already, set. forth. The illustrations which follow, from Fig. 68 to Fig. 76, Fig. 68 (^)uaaratus menti inclusive, demonstrate the chief movements of the muscles of expression innervated by the seventh nerve, and indi- cate the position of the electrodes when the muscles are to be thrown into action by faradic or galvanic stimulation. ^ Progres Medicale, 23-30 Avril, 1881. 190 ELECTRO-THERAPEUTICS, Fig. 69. Levator labii superioris alasque nasi. Fig. 70. ELECTRICITY IN THE PARALYSES. Fig 71. 191 Zygomaticus minor. Fig. 72 Buccinator. 192 ELECTRO-THERAPEUTICS. Fig. 73 Pr'oprius labii superioi-.s. ELECTRICITY IN THE PARALYSES. 193 Fig. 75. Levator menti. Zygomaticus major. 13 194 ELECTRO-THERAPEUTICS. The so-called rheumatic paralyses occur elsewhere, but very infrequently. Superficial nerves, as the ulnar and radial, and anterior and posterior tibial, are rarely affected in the same way as the facial and with the same symptoms. The plan of treatment is also the same. The seventh nerve is also sometimes injured by the forceps in delivery, and the infant consequently suffers from paralysis of that side of the face. More frequently the seventh is invaded in the aqueduct of Fallopius by disease of the middle ear produc- FiG. 77. Paralysis with atrophy of the muscles of the left shoulder. (HAMILTON.) ing caries of the bone. Inflammation is excited in the nerve, and its elements are disassociated and softened. The condition of the muscles is determined by the amount of injury done to the nerve. In these cases, also, are rep- resented the reactions of degeneration in the nerve and muscles. The power of response to the faradic current is quickly lost, and an abnormal readiness of contraction on ELECTRICITY IN THE PARALYSES. 195 galvanic stimulation is developed. The muscles also waste, and great deformity is the final result. When the nerve is destroyed by the suppurative infiammation, the case is hopeless, as regards cure and the restoration of the con- sentaneous action between the volitional impulse and the muscular movement. The condition of the muscles may be improved by persistent use of an interrupted galvanic current, but the supremacy of the will is permanently lost. When restoration of the nerve takes place, the muscles at first react only to the interrupted galvanic current ; after a time the faradic will excite them, as above stated. The position of the lesion, whether in front or behind the origin of the chorda tympani, is ascertained by the state of the palate and uvula, and the condition of the sensibility in the corresponding half of the tongue. In these cases, as in the examples of merely rheumatic inflammation, but to a greater extent, is persistence in the treatment necessary. Stabile and labile applications should be made, a strength of current being employed -merely necessary to induce muscular action in the paralyzed muscles. An olive-shaped electrode — the anode — well covered with soft leather and thoroughly moistened, may be placed nearest the nerve by resting on the anterior border of the external auditory foramen, A carbon electrode, of button shape, and well covered with soft sponge — the cathode — may be placed at various points on the peripheral distribution of the nerve, and held in position for a few seconds, and then removed to another point, until, in turn, the whole expansion of the nerve has been acted on. Daily stances of five to ten minutes should be persisted in for months, and years, if necessary, intermissions being allowed for a few days at a time. Various motor nerves subjected to injury, paralysis en- sues In the parts innervated by them. Thus, the pressure of a crutch, a severe blow, a penetrating or gunshot wound, 196 ELECTRO-THERAPEUTICS. may each by injury to nerve trunks induce more or less extensive paralysis, according to the importance of the nerve or nerves injured. The reactions of degeneration ensue in such cases, both in the nerves and muscles, but they are not the same in both. As regards the nerves, the irritability to both faradic and galvanic currents lessens gradually when the paralysis occurs, and at the expiration of one or two weeks has entirely disappeared. If the nerve undergoes degeneration, or cure, after a time, the galvanic excitability is slowly restored, beginning from the central portion and extending peripherally, and afterward the fara- dic excitability ; but the reaction to the stimulus of the will precedes the electrical ; in other words, voluntary motion is restored before the nerve reacts to the currents (Fig. yS). Fig. 78. Paralysis and atrophy of first dorsal interosseous muscle. The behavior of the muscles has been already described ; the faradic contractility disappears, and an abnormal readi- ness to contract to galvanism is developed. After a time the galvanic excitability declines to normal, and the faradic excitability is restored. We owe these important observa- tions on the phenomena of the reactions of degeneration to Erb.^ There is universal agreement as to the value of electricity in the peripheral paralyses to restore the muscles, ^ Deutsch. Archiv fiir klin. Medicin, vol. iv.-v., i^ ELECTRICITY IN THE PARALYSES. 197 and to prevent deformity (Fig. 79). Duchenne' especially details many examples of wasting- and deformity of the members, restored by suitable electrical treatment (Fig. 79). He prefers, as is usual, the faradic applications. He admits that those muscles whose faradic contractility is but Fig. 79. Stimulation of the hypothenar group. little affected recover speedily under faradic treatment, but that muscles having lost their power of response to the faradic current soon undergo atrophy. He advises faradi- zation, using at first strong, rapidly interrupted currents, the applications being ten to fifteen minutes in duration, daily, and afterward weaker currents (Fig. 80). Although Fig. 8c. i""tr«'iri;>i;itiii I Atrophy and contraction of the muscles of the hand. Duchenne achieved vary great results by faradic treatment, his practice was the less efficient because of his persistent opposition to galvanism. He was on the verge of dis- covering the facts subsequently ascertained by Erb, regard- ing the difference in the reactions of nerve and muscle, and ' De I'Electrisation Localisee, op cit. 198 ELECTRO-THERAPEUTICS. the reactions of degeneration in general. Besides the special electrical authorities who may be supposed to have predispositions in favor of their remedy, Rosenthal,' Erb,^ Eulenburg,^ and others, as strongly maintain the utility of electricity in these cases. Neuritis. — Since the publication of the last edition of this work the subject of neuritis has assumed new impor- tance as a factor in peripheral paralyses, motor and sen- sory. In this affection single nerve-trunks, or many, become inflamed ; the former is siviplc, the latter, multiple neuritis^ and a large number being invaded in quick suc- cession in the upper and lower extremities, and in the body, the affection is called general luiiltiple neuritis. The last mentioned has a great similarity in its clinical history to acute ascending paralysis (Landry's disease), and has been mistaken for it no doubt. The symptoms of neuritis vary with the stage of the inflammation. With the initial congestion there is a con- dition of heightened irritability of nerve and muscle — mani- fested in pain, spasm, and increased readiness of response to electrical stimulation ; but as the inflammation pro- gresses, and the nerve elements become damaged, the muscles lessen in power, and pain is succeeded by anaes- thesia. The trophic fibres of the nerves are impaired in structure with the other constituent elements, and wasting and degeneration are added to the other symptoms. In these cases ultimately very typical reactions of degenera- tion occur. In simple neuritis, one nerve-trunk involved, the muscles supplied by it will undergo the pathological changes above referred to ; in multiple neuritis, the extremities and parts of the trunk may be affected, and hence a general paralysis ' Klinik der Nervenkrankheiten, p. 66i. ^ Ziemssen's Cyclopaedia, vol. xi. p. 423 et seq. ^ Lehrbuch der fimctionellen Nervenkrankheiten, p. 363, op. cit. ELECTRICITV IN THE PARALYSES. 199 will set in. The order in which the paralysis of muscles takes place is not always symmetrical, but usually pro- ceeds from below upward. Beside the seat of the pain and the trophic changes in the skin, the position of the disease is indicated by the muscular groups undergoing atrophic degeneration. The electrical applications must be adapted to the stage of the disease. Durino- the stao^e of cong-estion with the o o o symptoms of increased irritability, only the galvanic cur- rent is applicable. As has been already insisted on, labile applications of a strong descending current — 20 to 40 mil- liamperes — must be employed, for in this way the vessels are made to contract energetically, and thus congestion is removed. If the case has passed beyond this stage, but only a quantitative decline in the reactions to galvanism and faradism has ensued, both currents should be em- ployed, a mild galvanic, slowly interrupted, to increase the circulation and improve nutrition, and a faradic current of sufficient intensity merely to cause some muscular con- tractions. If the reactions of degeneration are present, the galvanic and faradic treatment must be conducted according to the principles and methods already set forth. Under this head should also be included paralysis of the ocular muscles — innervated by the third, fourth, and sixth nerves, causing various deviations of the ocular globe, and corresponding disorders of vision. The current used should be determined by the electrical reactions of the muscles. As these may be examples of peripheral paral- ysis corresponding to that of the seventh, and known as rheumatismal, or due to inflammation of the nerve trunk induced by pressure of a neoplasm, the current most likely to be of service is the galvanic. Wecker' recommends the employment of six to eight elements in the beginning of ' Therapeutique Oculaire, Paris, 1879, P- 7°4 ^^ seq. 200 ELECTRO-THERAPEUTICS. the treatment, to be gradually increased to twelve, as the sensibility of the skin lessens. The positive pole is placed at the supra- or infra-orbital foramen, according to the position of the muscle to be acted on, and the negative — an olive-shaped electrode — is passed over the eye — the lids being closed — in the direction of the paretic muscle. This indirect or reflex method has quite taken the place of the direct stimulation of the muscles, and it has the further advantage of giving but little pain. According to Wecker, the electrical treatment produces very satisfactory results {produire des restdtats ti'-es-satisfaisants) (p. 706). Hysterical Paralyses. The hysterical paralyses form a distinct group, and are incidents of the hysterical state. They may occur in any voluntary organ, but are usually in the larynx, or upper or lower extremities, notably the last. They occur suddenly without any preliminaries except the complexus of hysteri- cal symptoms. The diagnostic peculiarities presented by them are, the absence of wasting or degeneration, usually absence of electro-sensibility, with entire preservation of electro-contractility — the muscles responding with the nor- mal promptitude to the faradic and galvanic currents. The separation of these from all other forms of paralysis cannot therefore be difficult. Without the aid afforded by electrical examination, however, hysterical paralysis might be very difficult of recognition. The treatment by faradization rarely fails to succeed. It not unfrequently happens that a single seance removes a long-standing paralysis, but on the other hand protracted treatment may be necessary, especially when from long disuse the muscles have wasted. In hysterical apJwnia there are two methods of pro- cedure which may be tried, the simpler first. The larynx ELECTRICITY IN THE PARALYSES. 201 may be stimulated by direct application, the electrodes resting on either side of the organ, and a succession of shocks transmitted by the faradic, or an interrupted gal- vanic current. The muscles of the lar^mx may be reached, also, by placing the anode over the course of the recurrent laryngeals, and the cathode over the larynx, and inter- rupting the current by cathodal opening and closing. The larynx, however, may be much more effectively acted on by the intra-laryngeal electrode. This procedure is to be preferred in cases of aphonia due to paresis or paral- ysis of the vocal cords, but in hysterical aphonia the mental impression made by faradic applications is an important factor in achieving a curative result, and may be as decided by external as Internal applications. Torrance' reports the cure of a case of aphonia of nearly five years duration, by faradization of the larynx. In hysterical paralysis of the extremities, the group of muscles refusing to do duty can be exercised by the faradic current, and as sensibility to the current is wanting, strong applications can be made. In this instance especially the temptation to use powerful currents Is great, but it should be restrained, since to fatigue and exhaust the muscles can only do harm. The cutaneous and muscular anaes- thesia which accompanies hysterical paralysis can be removed by the faradic brush. The skin should be thoroughly dried, and the brush drawn over the parts to be acted on. In the treatment of this affection, massage and suitable hygienic and tonic medication should be enforced, and massage especially when the muscles by long disuse have atrophied. A similar paralysis occurs In a group of spinal muscles on one side, which. If it continue for months and years, leads to wasting of the paralyzed muscles, and to overac- tion and spasm of the antagonistic muscles, on the other ' Lancet, May 7, 1881. 202 ELECTRO-THERAPEUTICS. side. Very great deformity may be thus produced, and often caries of the vertebra is diagnosticated and treated, to the serious injury of the patient. The electrical treat- ment is of the greatest service in such cases. The paretic and wasting muscles should be daily faradized with a strength of current sufficient to cause active muscular movements, and the overacting antagonistic muscles should have their irritabihty reduced by a stabile galvanic current from ten to twenty elements. As in these cases, also, tender points exist on the spine in various situations, they should be treated by the anode resting on them, and the cathode on the periphery of the corresponding spinal nerves — a stabile current passing for two or three min- utes at each place. Central galvanization, and the general electrization of Beard and Rockwell, may be advantage- ously combined with the other methods. The success of the treatment is the greater if at the same time the nutrition of the patient is improved by a suitable diet and regimen. The hysterical state attains its highest pathological expression in hcmiancesthesia, hystero-epilepsy, and the allied conditions. Although the diseases of a convulsive character have been discussed elsewhere in the thera- peutical section, hystero-epilepsy was not included, for the phenomena present in one of these attacks are hysterical and not epileptic. The paralysis of sensation in hemi- anaesthesia is very readily transferred, as is well known, by various metals and other objects. Faradization with the electric brush promptly removes it. The attacks of hystero-epilepsy are usually quickly terminated by suf- ficiently powerful faradic stimulation, so timed as to over- come the muscular rigidity of the paroxysm (Fig. 8i). Galvanization of the spine, the anode resting on the tender spot, is of great service in removing the excessive mobility — the explosive irritability — of the nervous system, if carried out faithfully during the interval between the ELECTRICITY IN THE PARALYSES. 203 seizures. The ovaries should also be carefully galvanized, by external electrodes so placed as to include them in the circuit, or by a vaginal and an external electrode, also Fig. 8i. Hystero-epilepsy. (Hamilton.) arranged to include the ovaries. To local treatment should be joined central galvanization, and galvanization of tender spots on the spine. Since the observations of Charcot, Arthius, and Vi- gouroux have been published, static electricity has been employed very generally in the treatment of the hysteri- cal paralyses. This mode of treatment has furnished the best results in all the forms of hysterical manifestations. General franklinization, drawing sparks from the spine and the extremities, and the application of the several kinds of current have been quite successful in the hands of various electropathists, in this country and abroad. Also, electric baths, which, within the past two or three years have become a sort of fashion ; but strong claims for their utilit}^ are put forth by such authorities as Corval and Wunderlich,' Schleicher,'' Trautwein,^ Stein,'* Ischewsky,^ ' Deutsches med. Wochenschrift, p. 2[, 1874. ^ Wiener med. Presse, No. 27, 1883. •^ Berliner klinische Wochenschrift, p. 37, 1884. * Neurologisches Cenlralblatt, No. 4, 1882. ' Ibid., No. 10, 1882. 204: ELECTRO-THERAPEUTICS. Eulenburg',' and others. They are usually made some- what saline, are monopolar or bipolar, and are supplied with galvanic, faradic, or galvano-faradic currents. How much of the curative action is due to an impression on the imagination of the patient, remains an unknown factor. Diphtheritic Paralyses. The paralyses succeeding to diphtheria may be limited to the muscles of the pharynx, or of the eye, or involve the muscular system of animal life in general. The con- tractility to the faradic current may be diminished or lost — usually, and in recent cases, merely diminished. More or less wasting of the paralyzed muscles ensues when the paralysis has existed for some time, and in that case the electro-contractility declines. Galvanism is more serviceable than faradism, because of its influence over nutrition. With local excitation of the paralyzed muscles should be conjoined central and sympathetic galvanization. When the pharynx is affected soon after the morbid pro- cess has ceased — but to the severity of which it does not bear a constant ratio — the palate is seen to hang limp and lifeless, the voice has a thick, stuffy, and nasal tone, and, in the attempt to swallow liquids, they are returned through the nose. An insulated button electrode — the anode — should be placed against one extremity, of the soft palate, and a corresponding one — the cathode — at the other extremity, and a mild (3 to 5 cups) current inter- rupted slowly should be transmitted for a few minutes daily. The eye muscles should be stimulated in the mode already described. The muscles of the extremities par- alyzed, or in a paretic condition, should be in turn acted on by an interrupted galvanic current — the anode placed on * Neurologisches Centralblatt, No. 6, 1883. ELECTRICITY IN THE PARALYSES. 205 the spine, and the cathode passed over the whole of the extremity affected. When individual muscles or groups are paralyzed, smaller electrodes must be employed to select out the muscles requiring stimulation, and the cur- rent confined to the parts affected. Very prompt action is demanded in the cases of paralysis affecting the respiratory organs. If the epiglottis and larynx are involved, suffoca- tion may be brought on in the attempt to swallow, or, escaping this danger, foreign bodies may be lodged in the lungs, exciting a fatal pneumonia. Direct galvanization of these organs may render very important service. When paralysis invades the organs of respiration, the pneumo- gastrics, phrenics, and the cervical plexus on both sides, and the muscles should be faithfully galvanized. Other remedies than electricity may be used with success, it is true, but the best results are obtained by the timely appli- cation of galvanism. If the symptoms are urgent, elec- tricity should certainly be used, in addition to other means. In the absence of proper galvanic appliances, faradism may be substituted. The above observations on paralysis following diphtheria are equally true of paralysis following other acute diseases. Lead Paralysis. Paralysis by lead usually takes the form of "dropped wrist," but it may also occur as paraplegia, hemiplegia, general paralysis, etc. In paralysis of the forearm, the symptoms pursue with considerable uniformity a defined course — a knowledge of which will aid in diagnosis. First, the extensor communis dimtorum is invaded ; next, the extensor indicis ; then the ulnar and radial extensors of the wrist, and ultimately the thenar muscles (the ball of the thumb). After a time the flexor muscles of the forearm and the triceps and the deltoid become weak and paretic. 206 ELECTRO-THERAPEUTICS. Fig. 82. Conv.VltinLi.v Dfjcp Pfroneat. Motor points, and distribution of nerves on the superficies. ELECTRICITY IN THE PARALYSES. 207 In consequence of the relative weakness of the extensors as compared with the flexors of the forearm, should paralysis affect both in an equal degree, the over-action of the flexors would bring about dropping of the wrist. The electro- contractility declines as the paralysis increases ; more or less wasting of the muscular elements takes place, and ultimately the responses to both currents cease, and the muscles disappear, being replaced by connective tissue and fat. For a period before the final disappearance of the electro-contractility, the muscles respond only to a slowly interrupted galvanic current. The electrical treatment consists in galvanic applications by the labile method. When the whole arm is involved, the anode is placed over the cervical plexus, and the cathode is passed over each muscular group in turn. The interrup- tions consist, therefore, of cathodal opening and closing. When the extensors of the forearm are alone affected, the applications to the muscles should be by the indirect method : the anode resting on the motor nerve, and the 1. Seventh or facial nerve filament supplying the Frontal muscle. 2. " " " •' Levator labii superioris alseque nasi. 3. " " " " Zygomaticus minor. 4. " " " " Orbicularis oris and quadratus menti. 5. Phrenic nerve supplying the Diaphragm. 6. Musculo-cutaneous nerve -' Biceps, brachialis, etc. 7. " nerve " Brachialis internus. 8. Ulnar nerve '• Muscles of forearm and hand. 9. Radial nerve " Flexors of thumb and fingers. 10. Ulnar nerve " Palmaris brevis, abductor digitor. min., opponens digitor. min., etc. 11. Obturator nerve " Sartorius, adductor longus, etc. 12. Crural nerve " Adductor longus, vastus internus, etc. 13. " " Vastus externus. 14. Musculo-cutaneous nerve " Flexor digitorum com. long. 15. Occipital nerve " Posterior neck muscles. 16. Circumflex nerve " Triceps, etc. 17. Intercostales nerve " Lumbar muscles. 18. Gluteus nerve " Adductor magnus, etc. 19. Popliteal nerve " Gastrocnemius externus. 20. " nerve " Soleus. 208 ELECTRO-THERAPEUTICS. cathode on the belly of the muscle or on the muscular ^roup. If the muscles have not yet lost their power of contraction to faradic stimulation, galvanism should never- theless be preferred. The power of diffusion possessed by the galvanic current and its effect on the vermicular motion of the arterioles, and secondarily on the function of nutri- tion, render it more useful in lead poisoning than is fara- dism. Faithful and persevering treatment is necessary to procure the best results. Noth withstanding the unques- tionable utility of electricity, it should not be relied on to the exclusion of all other treatment, including the agents of elimination. The iodides and bromides to form soluble combinations, and to procure elimination by the kidneys, strychnine to excite muscular action, and massage, are important aids in obtaining curative results, but galvanism is the most necessary of all the remedies, and faradism when it can excite muscular action. In that form of lead paralysis manifested in colic. Dr. Rothe' has had admirable results from the application of faradic electricity when other powerful means had failed, and from obstinate constipation due to the same cause — to lead paresis of the muscular layer of the bowels — Hudson' has succeeded by the use of galvanism. In these cases of bowel affection, it is best to introduce one electrode into the rectum insulated up to the terminal metallic button, and a large sponge electrode placed over the course of the caecum and colon. The galvanic current should be slowly interrupted. ' Memorabilien, No. 8, 1880. '^ Medical Times and Gazette, 1885. ELECTRICITY IN THE TREATMENT OF PAIN. 209 CHAPTER VI. ELECTRICITY IN THE TREATMENT OF PAIN. There is no fact more certain than the power of galvan- ism to reheve pain. A rapidly interrupted, high tension faradic current has to a much less extent the same power. Galvanism can relieve pain when it has no effect on the cause of it, so that its pain-relieving power is an inherent quality. The physiological actions of galvanism do not explain this property, for although a descending stabile current allays irritability, and an inverse current increases it, in practice the direction of the current seems of little moment, pain being relieved in what direction soever the current is passing. It is, however, good practice to apply the anode to painful spots. The seat of pain should, of course, be included in the circuit, under any circumstances. In neuralgia of the fifth nerz^e, tic douloureux, or simple neuralgia, the galvanic current affords relief, but is rarely more than palliative. Besides the fact that tic douloureux is often caused by lesions that cannot be removed — an exostosis for example — the nerve lies so deeply that the influence of the current is dissipated before reaching it. Curative results are sometimes obtained in cases of irrita- bility of the submaxillary, of the infra- and supra-orbital divisions of the fifth, due to cold, carious teeth, etc., the pain persisting after the cause is removed. It is true, in the main, that galvanism is merely palliative in neuralgia of the fifth. This opinion is supported by Anstie,' Bene- dict,^ and other observers Far different is the effect of galvanism on cervico-bracJiial neuralgia. In a considerable ^ Neuralgia and its Counterfeits, p. 200 et seq. ^ Electrotherapie, op. cit. 14 210 ELECTRO-THERAPEUTICS. experience in the treatment of this form of neuralgia which includes cases treated by all the most improved methods except galvanism, but including subcutaneous injection of morphine, I have rarely failed to effect a cure. Close attention must be given to the cases, and sufficient time. The usual error consists in too infrequent applica- tions. The best results are obtained from seances of five to ten minutes duration, repeated three times a day, cer- tainly twice a day. The anode is placed over the cervical Fig. 83. a. jSIusculo-cutaneous. b. Biceps. c. Musculo-cutaneous. d. Cap. intern, mus, tricipit. e. Median nerve, f. Brachialis internus. g. Ulnar, h. Branch of median. plexus, and should consist of a large sponge electrode well moistened with hot water ; the cathode, of similar form, should be slowly passed over the shoulder, arm, and fore- arm — labile method, or, what is more effective, the cathode held stationary at some point on the wrist or hand — stabile method. Probably even better results are obtained from the polar method — that pole applied to the seat of pain, most active in relieving it, and the other at any indifferent point. If the case is recent, from 10 to 20 elements — 5 to 10 milliamperes or more — will suffice; but if old, trom ELECTRICITY IN THE TREATMENT OF PAIN. 211 20 to 40 elements — 10 to 20 milliamperes or more — will be necessary. Onimus and Legros' Insist on the impor- tance of employing a current of considerable tension, but having feeble chemical effects. There is much importance in this suggestion, if I may trust to my own observations. The same principles apply to intercostal neuralgia, and to the trophic form of this disease known as herpes zoster. Fig. 84. " — S ^' \% ,_ _^ t P / )" / _ J^_ ^ ;_ ^l Nervi inter- XT ■ ■ I fe^ ' ' costales. Nervi inter- f ^ costales. V ~ i , Vj \ Transversus x "A^X '■"' A\ abdominis Nerves aftected in herpes zoster. (Fig. 84.) In treating these affections, the anode rests on the spine at the point of emergence of the nerve roots, and the cathode at the periphery about the median line of the body in front. It is good practice in these cases, also, to employ the polar method — to place the anode on the pain- ^ Traite d'Electricite medicale, p. 298 et seq. 212 ELECTRO-THERAPEUTICS. ful points, where the nerves become superficial, and the cathode on the terminals. The applications may be both labile and stabile. Neumann' reports a case rebellious to galvanism", cured by two seances of cutaneous faradization. In no painful affection is the application of electricity more conspicuous for good than in sciatica. There is a general agreement amongst authorities as to the excep- tional value of galvanism in this disease, and yet, several cases have been reported in which faradism was more effective. My own experience is decidedly in favor of a large number of milliamperes — 20 to 40 — in old cases, which I have seen yield in a surprising manner to the ap- plications. The method advised by Onimus and Legros may be pursued. A large sponge-covered electrode — the anode — well moistened with warm water, without salt, is placed over the nerve at its point of emergence from the pelvis ; and the cathode, equally large, should be applied by the labile and stabile methods over the distribution of the nerve, special attention being given to the painful points. Forty to sixty elements should be used, and the applications made twice each day, if practicable, but always once a day. Benedict^ proposes another mode of applica- tion, which he has found effective : he uses a bulbous elec- trode, which is introduced into the rectum, and directed to the position of the sciatic. Eulenburg^ advises a current from twenty to thirty elements, and stabile applications, the sittings from five to ten minutes. Hammond succeeds in effecting cures in a very short period of time by em- ploying electro-puncture, which consists in introducing a suitable needle insulated nearly to its point, and connecting- it with one of the poles. I have not found this method ' Gazette med. de Paris, No. 7, 1878. Nevralgie intercostale rebelle au courant continu, guerie en deux seances de faradisation cutanee. ^ Wiener med. Presse, Nos. 21 and 22, for 1872. ^ Lehrbuch der funct. Nervenkrankheiten, etc., p. 169. ELECTRICITY IN THE TREATMENT OF PAIN. 213 effective, and it is painful — not more than one or two milliamperes being borne with any degree of satisfaction. A great many reports showing the utihty of galvanism in sciatica have been published. Beside the special treatises, the reader may consult with advantage the papers of Knot,' Stephenson,^ Seegen,^ and Gibney/ Litinbago is usually promptly cured by galvanization of the affected muscles. In my experience in this class of cases, strong currents are most beneficial; attacks resist- ing the current from fifteen to twenty cups of Siemens and Halske have promptly yielded to forty to sixty. The ap- plications should be made twice a day for the first few days, and afterward daily until a cure is effected. Immediate relief is afforded by the passage of a current, the patient being able to straighten himself at once without pain, but in the intervals he lapses back into his former condition nearly, but the repetition of the applications is followed by an increasing duration of the relief. Recent cases are more amenable to cure than old cases, and sometimes are cured by a single application. The best results are ob- tained by transverse currents and by the polar method, the electrodes, which should be large, being placed on each side in the one case, and on the seat of pain in the other. Both stabile and labile applications should be practised. Alyalgia in other situations is generally quickly relieved by electrical treatment applied in the same way as de- scribed for lumbago. The direction of the current has ' Lancet (London), Dec. i8, 1875. ' Med. Press and Circular, Jan. 3, 1872. ^ Wiener med. Presse, Nos. 34, 35, 37, and 38, for 1872. * American Practitioner, March, 1879. "Galvanism in the Treatment of Sciatica." He reports fifteen cases treated by galvanism alone successfully. In the Medical Record of June 7, 1884, Gibney again reports on the value of galvanism in sciatica, and affirms the importance of strong applications. In referring to this paper, Bernhardt appends Bekajinies ; but if notoriously true, the fact is not as often acted on as it should be. 214 ELECTRO-THERAPEUTICS. apparently but little influence, but in my experience trans- verse currents are more effective in muscular affections. The operator will do well, however, to pass the current through the muscles affected in both directions, and the anode on the spine, the cathode passed over the muscles by descending labile applications. The pain, soreness, and muscular feebleness which per- sist for some time after an attack of acute rhciiniatisui, are greatly relieved by galvanism, a descending labile current of moderate strength being most efficient. The effusions into the sheaths of tendons left by rheumatism, become absorbed under the stimulation of electricity. Great relief is afforded in cJironic rhciLuiatisni by persistent galvanic treatment. Patient and painstaking applications may bring about absorption of inflammatory exudations around joints and in the sheaths of tendons. Meyer reports having caused the disappearance of nodosities about joints in chronic rheumatism by galvanization of the cervical sym- pathetic, and Althaus' subsequently published similar ex- perience. Such a result is explicable only on the theory that in this way stimulation of the trophic system was effected in such a degree as to excite absorption of the morbid deposits about the joints. This method, as well as central galvanization, may be conjoined to the local gal- vanic applications. In their report on the results of electrical treatment, as administered in the wards of Prof. Schwanda, Drs. Gumplowiez and Klotzberg speak in strong terms of the value of electricity in rheumatismal affections. The most numerous and satisfactory of the cases falling under their care were the rheumatic affections of the muscles and joints. "With the greatest caution in estimating thera- peutic facts," they say, "in view of the success, often truly ' The British Medical Journal, Sept. 28, 1872. ELECTRICITY IN THE TREATMENT OF PAIN. 215 surprising, which we have obtained, we may affirm with confidence, that electricity is a sovereign remedy in most rheumatic affections." In cases of. muscular rheumatism with paresis of the affected muscles, they hold that an interrupted galvanic current should be used ; in chronic articular rheumatism, cutaneous faradization is preferable.' Seligmiiller^ has used galvanism with great effect in cases of chronic rheumatism. He employed strong currents (15 to 20 elements, of Siemens — 10 to 20 milliamperes), and in cases with thickening of the tissues and nodosities combined, the application of hot baths to the affected joints, massage and faradism to the weak or wasted muscles. The gfood results obtained by Seeligmiiller by this method, have been since confirmed by Bottger,^ who has treated in the same way with success cases of chronic rheumatism. In the examples of this affection that prove obdurate to ordinary therapeutic methods, with galvanism of the affected joints should be combined central o-alvanization. The various neuralgic affections situated in superficial nerves have been treated with success by faradic applica- tions, by many electro-therapeutists, notably by Duchenne, and by Mitchell, Morehouse, and Keen. It is most ser- viceable when applied as follows : the skin is thoroughly dried, and then some drying powder is dusted over the surface to be acted on. A strong faradic current with excessively rapid interruptions is then applied along the trajectory of the nerve by means of the brush or metallic terminals. I have seen excellent results obtained in this way, in the more chronic neuralgic and rheumatic affec- tions. To the electric action pe?- se is superadded the counter-irritant effect of a current of hio-h tension. Be- sides the galvanic and faradic modes of treatment just ^ Wiener med, Presse, Nos. 14, 17, and 19, for 1874. ^ Deutsch. med. Wochenschrift, No. 42, 1883. ^ Inaug. Dissert.; quoted in Virchow and Hirsch's Jahresbericht, vol. i, 1884. 216 ELECTRO-THERAPEUTICS. referred to, some attention must be p^iven to the thera- peutical effects of the combined currents — the galvano- faradic. Every pole^board properly equipped, now con- tains arrangements for turningf the faradic on to the wire conveying the galvanic current, and thus at the same moment the patient receives the continuous galvanic current and the interrupted and induced faradic. The result of the combination is that the galvanic current is rendered more stimulating, and the faradic is deprived of much of its irritating effect. My experience of the utility of the combined currents in nerve and muscle diseases, is confirmatory of the observations made by De Watteville,' who seems to have been one of the first to employ it, and of Stein,^ and Eulenburg,^ who have made use of this method in the treatment of various painful affections. It may be desirable to supplement the forgoing observa- tions by some additional facts, of an explanatory kind. As regards the applications of faradic electricity, there are two modes followed. One method consists in the use of the secondary current with excessively rapid interruptions, the spinal origin and the peripheral expansion of the nerves being in turn acted on. The other plan consists in applying a Ary metallic electrode or a brush of fine wires, to the skin carefully dried. Excited in this way, the skin may be merely reddened, or burned so that the epidermis peals off Two therapeutical effects are obtained from these faradic applications : one is the counter-irritant effect ; the other is the more distant vaso-motor influence — for as Rumpf,'* Feinberg,^ and some other observers have shown, cutaneous faradization of one limb causes a rise ^ Introduction to Medical Electricity. ^ Zur Galvanofaradization. Neurolog. Centralblatt, No. 8, \\ 3 Ibid., No. 6, 1874. * Op. cit. ^ Zeitschr. fiir klin. Med., vol. 7, p. 282. ELECTRICITY IN THE TREATMENT OF PAIN. 217 of temperature in the other, and general faradization in- creases the temperature of the whole body. The g-alvanic current is also applied in two modes : by the polar method — one pole placed on the seat of disease, or on the tender points, and the other on some indifferent point ; by the ordinal*)^ application of both poles — the positive placed on the spine or over the nerve at its point of emergence, and the negative at the peripheral expan- sion. The applications may be stabile or labile. If labile, the positive pole is placed over the trunk of the nerve, and the negative is brushed over the whole peripheral dis- tribution. Very recently Dr. Moritz Meyer' has published some very striking cases, illustrating the good results obtained from anodal application to "painful pressure- points." These painful points are discovered on pressure at various places ; at the spine, at spots along the course of the nerve trunks, and the branches. To these points the anode is applied for a few minutes. Success has been obtained by this method, when the usual galvanic applica- tions failed. By any of these modes of application, the so-called catalytic effects are obtained. The local galvanic treat- ment may also be effectively supplemented by central galvanization, by stimulation of the ganglia of the sym- pathetic, and by general faradization. All of these applications stimulate the vegetative functions, which are depressed to a greater or less extent, and they all promote nutrition. Visceral Neuralgia. Hemicrania, or migraine (sick headache), usually re- garded as a neuralgia of the fifth, is a very different affection from tic douloureux, or simple neuralgia, and ' Berliner klinische Wochenschrift, No. 31, 1881. 218 ELECTRO-THERAPEUTICS. belongs rather to this division of the subject. It is closely associated with stomach disorders, for the reason, doubtless, that the nucleus of the fifth and the nucleus of the pneumogastric lie in close proximity, and are con- nected with commissural fibres. Treatment directed merely to the nerve will, therefore, usually fail, and equally unsuccessful will be the management which is confined to the stomach disturbance ; both methods must therefore be conjoined. The ophthalmic division of the fifth, of either side, is the seat of the pain. The treatment by galvanism consists in applications to the fifth nerve — the anode on the supra-orbital nerve and the cathode on the mastoid. Stabile applications are preferable. Galvanization of the sympathetic is an im- portant addition to the treatment of the nerve. Du Bois- Reymond, himself a sufferer, was the first to point out the vaso-motor and pupillary phenomena in these cases. The necessity for galvanic treatment of the pneumo- gastric is not less obvious. The cervical sympathetic and the pneumogastric can be simultaneously galvanized by placing one electrode behind the angle of the jaw, and the other on the niannbriiuu steinii, or on the epi- gastrium. The treatment during the paroxysms is at least merely palliative. During the interval between the seizures besides a careful regulation of the diet and general hygiene of the patient, the irritability of the nervous apparatus should be removed by systematic daily applications of galvanism to the fifth, the sympa- thetic ganglia, and the pneumogastrics. An evident improvement in the body nutrition takes place, the attacks diminish in number and lessen in violence, and ultimately they cease to reappear in a considerable pro- portion of cases. During these paroxysms, in those cases of hemicrania accompanied by flushing of the face, throbbing tempo- ELECTRICITY IN THE TREATMENT OF PAIN. 219 rals, and increased action of the heart, reHef may usually be afforded by a very mild faradic current confined to the skin of the painful region, and a stronger current to the cervical and dorsal spine. The interruptions must be as rapid as possible, and the current strong enough merely to produce a faint tingling when applied to the eyelids and forehead. The electric hand is a good method of application under these circumstances. The person of the operator charged, the fingers of the dis- engaged hand are slowly passed over the affected area, for a period of ten minutes. Electricity is useful in all the forms of angina pectoris, but the best results are obtained from the applications when the cases are free from recognizable cardiac changes. In true angina pectoris, the effect of judicious treatment is to diminish the violence and lengthen the interval between the seizures. For obvious reasons, the paroxysms cannot be subjected to treatment. In hysterical and simple neuralgic angina, the paroxysms may be treated and the pain relieved by applications of the faradic and galvanic currents, the former employed as a counter-irritant to the walls of the chest, and the latter applied to the pneumogastric and to the sympa- thetic, the positive pole behind the angle of the jaw and the negative over the praecordial and epigastric regions. Employing galvanism in the interval, Eulen- burg^ had very good results in several cases of the genuine malady, the paroxysms being rendered lighter and less frequent, Gastralgia, enteralgia, hepatalgia, and other neuralgiae of the nerve plexuses in the abdomen, are to a greater or less extent improved by galvanism when they assume a subacute or chronic form. When a constitutional con- ' Lehrbuch der functionellen Nervenkrankheiten, loc. cit. 220 ELECTRO-THERAPEUTICS. dition underlies the low morbid state, attention must be directed to its relief. The strumous, syphilitic, paludal, or plumbic cachexia may be concerned, and, until special treatment is directed ao-ainst it, relief cannot be obtained. The cure of the cachexia may finally dispose of the pain, but it is not unfrequently the case that the habit of pain once induced in the nerve, persists after its cause has been removed. The various abdominal neuralgiae are best treated by a rectal electrode, and a large sponge- covered electrode applied to the epigastrium, right and left hypochondrium, and the other regions in turn. It is probable that excellent results could be obtained from a properly insulated electrode for the stomach, in cases of gastralgia and of neuroses affecting the semilunar gan- glion and solar plexus especially. Faradic electricity may be used also in these cases — a mild current and very rapid interruptions — for the anodyne effects, and a strong current to the skin only as a counter-irritant. In making applications for the relief of abdominal neuroses, it is good practice to include galvanization of the pneu- mogastrics and of the cervical sympathetics, and of the dorso-lumbar enlarcjement of the cord. CHAPTER VII. ELECTRICITY IN ANAESTHESIA AND ANALGESIA. Cutaneous anaesthesia and analgesia may be produced by various causes ; by division of the nerve trunk inner- vating the part ; by lesions of the cord or brain. It may also be an hysterical condition, and one of the protean forms of hysterical manifestations, as hemiansesthesia, or bilateral anaesthesia. It may occur as a sequel of typhoid ELECTRICITY IN AN.ESTHESIA AND ANALGESIA. 221 or Other acute affection, when it occupies a small area usually of an extremity. It is a frequent symptom in cases of syphiloma of the middle fossa of the skull, and involving the pons when it is bilateral, although not universal, but in patches. The sense of touch may be involved only, and the needle compasses felt as two when very far apart, or are not felt at all ; in other words, the anaesthesia may be partial or complete. The sense of touch may be retained and the sense of pain abolished, or vice versa, or both may be wanting, thus indicating that the senses of touch and pain are separate endowments of the nervous system. In the treatment of these affections physiological data may be applied with success. A descending galvanic cur- rent allays irritability, and an ascending current has the opposite effect. In the electrotonic state, catalectrotonus is a condition of heightened irritability. As a rule, the faradic current, beino- more excitino-, is more effective in treatinof these states. As the current is to be confined to the skin, the part requiring the treatment must be care- fully dried, dusted with some drying powder, and the applications made by the electric brush or metal electrodes. When anaesthesia is accompanied by languid circulation, and a tendency to trophic degeneration, galvanism is more efficient. An ascending current interrupted (labile) is the form of current most useful under these circumstances. The stronger applications are required as a rule. The most important of the anaesthetic affections are those involving the nerves of special sense. Anosmia, loss of the sense of smell, may be a state of merely functional depression of the olfactory nerve, but is more frequently the result of disease of the Schneiderian mucous mem- brane, or of some intracranial lesion. The functional condition only may be amenable to electrical treatment, but in my experience this has proved rebellious, and such 222 ELECTRO-THERAPEUTICS, is the testimony of other observers ; ' nevertheless, Du- chenne reports successes with faradization in those cases dependent on alterations of the mucous membrane. There is abundant testimony as to the efficacy of elec- tricity in anaesthesia of the retina — amblyopia, hcincj^alopia, ainaitrosis, ancBinia of the optic disk, etc. Successful cases have been reported by Pye-Smith,^ Frazer^ (Donald), Benedict/ Arcolo,^ Seely,^ and others. A form of func- tional depression of the optic nerve now very common is the tobacco amaurosis. Electricity affords prompt relief in these cases if the habit is relinquished. l\ similar condi- tion is induced by sexual excesses, and other causes of functional depression. Whenever anaemia exists, galvanism ought to be employed ; on the other hand, when hyperaemia is present, faradism. As anaemia is much the more com- mon, galvanism is more useful. Applications can be made directly to the eyes. The anode, well moistened, should rest directly on the closed lids, and the cathode on the malar bone or temple. The strength of current should not be greater than sufficient to cause faint flashes of light, and the stances not longer than two or three minutes. Besides the direct applications to the eye, this organ can be acted on indirectly through the cervical sympathetic, to which treatment should also be directed. When faradism is employed, the current should be rapidly interrupted, and not stronger than can be readily borne. The extra cur- rent is well adapted to the treatment of these cases. The use of faradic and interrupted galvanic applications, in the treatment of muscular troubles of the eyes, has been dis- cussed in a previous chapter. ' Althaus, p. 534. Op. cit. ' The British Medical Journal, May 18, 1872, p. 54. ^ The Glasgow Medical Journal, Feb. 1872, p. 163. * AUg. Wien. med. Zeit., Nos. 41, 43, and 44, for 1872. " Arcolo : abstracted in Virchow und Hirsch's Jahresbericht, 1873. ^ Archives of Electrology and Neurology, Nov. 1874, p. 213. ELECTRICITY IN ANESTHESIA AND ANALGESIA. 228 Aiicesthesia of the auditory nerves has received a new and admirable interpretation by the investigations of Brenner. Stimulation of the nerve by the galvanic cur- rent produces certain reactions or sounds. The ear is filled with warm water, with which the electrode commu- nicates, or a special electrode is employed, the ear, also, containing as much water as it will hold. Immediately on closing the circuit with the cathode (KS), a noise is heard, and it lessens as the closing proceeds. Cathodal opening (KO) produces no reaction, or at least causes no sounds. Anodal closing (AS) has no effect, but at the anodal opening (AO), if a current of sufficient strength is used, a sound is heard. The method of Brenner, or the "polar method," has been the subject of much discussion, but the opposition to Brenner's results has much declined, since his views have received the powerful support of Erb, and other influential electrologists. Wreden,' who has worked in conjunction with Brenner. Weber,^ and Netfel,^ have also had good results from the polar method. Although I have not often succeeded in obtaining the reactions from the auditory, described by Brenner, I have had good effects from galvanism, in dulness of hearing, noises in the ears, inflammatory thickening of the drum, etc. Rumbold,^ Itard,^ and others, have stopped tinnitus auriuni after it had in some cases existed for years. It is impossible before- hand to designate with accuracy the cases of dull hearing which will be improved by electrical treatment, except by exclusion, separating those in which the impaired audition is a result of incurable disease of the auditory canal, the drum, and the middle ear. Persevering treatment may be necessary even in favorable cases. On the other hand, very marked improvement has been caused by a single application, or by a few applications. Virchow und Hirsch's Jahresbericht, vol. vi., 187 1. - Ibidem, vol. vi., 1871. ^ Galvanotherapeutics, op. cit. * Archives of Electrology and Neurology, 1874. ^ These de Paris, 1874. 224 ELECTRO- THERAPEUTICS. CHAPTER VIII. ELECTRICITY IN THE VASO-MOTOR AND TROPHIC NEUROSES. The vaso-motor and the trophic system are not neces- sarily the same. The functions of the former may be very much disturbed without any alteration in the nutrition of parts. On the other hand, lesions of certain nerves are followed by trophic alterations in the parts to which they are distributed : injuries to the ophthalmic division of the fifth are followed by destructive ulceration of the cornea, inflammation of the conjunctiva, etc. When the multipolar ganglion cells of the anterior cornua of the spinal cord are diseased, there ensues rapid wasting of the paralyzed parts. These facts rather indicate the existence of a special trophic system. Nevertheless, we may conveniently study in one chapter the action of electricity on both, Exophthabnic goitre is the type of an affection of the vaso-motor system, when it is free from structural changes in the heart and orreat vessels. The normal inhibition of the cardiac movements is lowered and the vascular tonus is equally debased, the effect of both being to increase the rate of pulsation. The action of the heart is rapid and boundine, and the radials, the carotids, and the vessels of the thyroid gland beat vehemently. The disturbance in the functions of the sympathetic system needs to be the only pathological condition present ; but in cases of long standing and in old subjects, various changes take place in the heart, the aorta, the thyroid gland, and in the tunics of the vessels generally. (Fig. 85,) Recent cases treated efficiently by galvanism are relieved permanently, or the course and progress much modified. During exacerba- VASO-MOTOR AND TROPHIC NEUROSES. 225 tions, which constitute a prominent feature of the clinical history, the passage of a sufficient galvanic current through the pneumogastric immediately lessens the cardiac excite- ment. In the treatment for curative results, a mild current is held to be most efficient (Chvostek). An electrode — Fig. 85. Exophthalmic goitre. the anode — is placed in the angle behind the jaw, and the cathode on the epigastrium, and a stabile current is allowed to flow for three to five minutes. The cervical spine should also be galvanized. It may be included in the circuit, by placing the anode over the vertebra in turn, whilst the 15 226 ELECTRO-THERAPEUTICS. cathode rests on the epigastrium. Stabile may be varied by labile applications. The faradic current may also be used successfully, an instance of this having come under my notice. The first published cases illustrating the cura- tive value of galvanism, were those of Chvostek,' who fol- lowed with a new series of examples the next year,'' when Meyer^ also reported several cases. In 1874, I read a paper before the medical section of the American Medical Asso- ciation, advocating this plan of treatment, and illustrated its advantages by the details of five cases. In 1878, Vizioli,' in a paper on electrotherapy, amongst other cases, narrated several of Basedow's disease, cured. In making the claim for the curative power of electricity, the reader should understand that uncomplicated cases only are referred to. Since the publication of the previous editions of this work my experience with this mode of treatment and the general published experiences, continue to be favorable ; but, as already observed, those examples of the disease due to functional derangements are more manageable than those in which the exophthalmic goitre is merely symptomatic. Very brilliant results have been obtained from galvanism in the treatment of trophic affections of the skin. I first employed galvanism for the cure of acne (acne vulgaris) with success ; the whole integument of the face being stim- ulated by the electrodes. The direction of the current seems to be unimportant. From five to ten elements are necessary. One electrode may be placed in front of the ear, and the other passed over the eruption. The imme- diate effect is to irritate the skin and flush the face, but these symptoms^quickly subside, leaving the face pale and 1 Wiener med. Presse, Nos. 41, 42, 44. 45, 46, 51, nnd 52, fur 1871. "^ Ibid., Nos. 23, 27, 32, 39, 41, 43, 44, 45. and 46. 1872. ^ Berliner klinische Wochenschrift, No. 39. 1872. * Elettroterapie practica. Morgagni, Gennajo, p. 69, 1878. Quoted and abstracted by Virchow u. Hirsch Jahresbericht, 1878. Eulenburg, also, speaks favorably of the good effects of galvanism. Ziemssen's Cyclopaedia, vol. xiv. VASO-MOTOR AND TROPHIC NEUROSES. 227 the eruption less prominent. A cure can easily be effected by persevering treatment in the worst cases. Some atten- tion to diet is also necessary, and as the eruption appears at the period of puberty, correction of menstrual irregulari- ties may be required, and of moral irregularities on the part of boys. Dr. G. M. Beard called attention, in 1872,' to the treatment of affections of the skin, presumably of neurotic origin. He employs central and peripheral gal- vanization and general electrization, as he has defined and illustrated these modes of treatment. The affections in which he employed electrical treatment with success were, eczema, psoriasis, and prurigo. Dr. G. W. Murdock- re- ports a case of eczema capitis cured in six weeks of electrical treatment after it had existed nine months. Dr. Piffard,^ of New York, the author of a valuable work on skin diseases, and inventor of a beautiful galvano-caustic battery, has published an essay on the value of electricity in the treat- ment of skin diseases. More recently Armaingaud* has reported the cure of scleroderma by galvanism, an electrode — the anode — being placed on the spine, and the cathode applied to the diseased surface. He employed from twelve to twenty-seven elements. Not less remarkable are the results obtained in the treatment of ulcerations of the skin. The healing of bedsores by galvanic couplets has been long known. A most interesting case, as showing the curative power of electricity, has been published by Dr. Deering.^ Extensive and numerous ulcers of a limb, succeeding- to '.'milk-leg," were cured by galvanic treatment, in which the anode was placed on the spine, and the cathode on the ' American Journal of Syphilography and Dermatology, Jan. 1872, p. 12. '^ Archives of Electrology and Neurology, vol. ii. p. 26, May, 1875. ^ New York Medical Record, March 11, 1876. * L'Union Medicale, 132, 1878. ^ Galvanism in Strumous Ulceration. The American Journal of the Medical Sciences, April, 1873. 228 ELECTRO-THERAPEUTICS. foot, the whole Hmb being included in the circuit. Not less remarkable are the results obtained by Glax' in the treat- ment of a'dema (general) and ascites by faradism. His method consists in procuring active muscular contractions by applying one electrode to the motor point and the other on the belly of the muscle (indirect electrization). Absorp- tion, according to Glax, takes place when the muscles are made to contract sufficiently. The maladies in which this practice has succeeded are oedema from mitral insuffi- ciency, oedema from emphysema and mitral insufficiency, and oedema from tricuspid disease. He claims to have succeeded, also, in cases of ascites from hepatic disease. CHAPTER IX. ELECTRICITY IN CONSTITUTIONAL DISEASES. In cerebral, spinal, and peripheral nervous affections of syphilitic origin, I cannot speak too strongly of the good effects of electricity in restoring functional activity after preliminary mercurial or iodine treatment has removed the specific lesions. There is a period in the course of these affections when, after an arrest of the morbid process, and absorption of the exudations, an inaction of the affected tissue persists. Galvanic and sometimes faradic applica- tions will, under such circumstances, raise the tonus of the vessels and excite the depressed functions to renewed activity. In syphilitic paraplegia especially . have I seen good results from combined spinal and nerve-trunk appli- cations. The presence or absence of the reactions of degeneration will depend on the seat and character of the ' Deutsches Archiv fiir klin. Medicin, vol. xxii. pp. 611-618, for 1878. ELECTRICITY IN CONSTITUTIONAL DISEASES. 229 lesions, and the current employed will necessarily be de- termined by the character of the reactions. The methods employed will be the same, of course, as for the non-specific diseases of the same tissue and organs. Great relief is afforded to the pain of nodes, and absorption promoted by galvanism. In the neuralgia of the so-called tertiary disease, as it occurs in old subjects who have been saturated in turn by mercury and iodine, and are much broken in health, it constitutes a most precious resource. In such cases central galvanization should be practised as well as the applications to the affected nerves. Remak' long ago insisted on the value of electricity in the treatment of cJrronic rJicuniatism. To explain the re- sults he utilized his convenient phrase — catalytic effects. I have already alluded to the relief to pain, and the absorp- tion of effusions into and about joints, which take place under the galvanic applications. Similar relief is afforded in gout, after the acute symptoms have subsided somewhat: the pain is relieved, and the swelling removed. Faradism has also been used with success in rheumatism, by Betz^ and Abramovski.3 Within the past three years numerous cases of rJieuiuatisni, even of chronic rJienniatic arthritis, have been reported by Stein,* Seeligmuller,^ Baierlacher,^ and others, cured or greatly ameliorated by electrical treat- ment. The particular methods employed have been various, chiefly galvanism, in the form of labile and stabile applica- tions to the affected parts with central galvanization ; also ^ Galvanotherapie — French edition, translated by Dr. A. Morpain. Paris, i860, p. 232 et seq. '^ Archiv fiir klin. Med., xviii. 482-495. ^ Berliner klin, Woch., 7 and 8, 1876. * Die faradische Behandlung der Olastipation und der nervosen Entero- pathie. Erlenmeyer's C. Bl. Virchow und Hirsch's Jahresbericht for 1882. ^ Ueber die electrische Behandlung des chronischen Gelenkrheumatismus und anderer chronische Gelenkaffectionen. Deutsche med. Wochenschr., No. 42, 1883. « Ibid. 280 ELECTRO-THERAPEUTICS. electric baths ; in a few instances faradism and franklinism. Seelig-niiiller advocates currents of considerable streneth (15—20 elements of Siemens and Halske). the positive pole applied by means of the metallic brush to the affected joint. In the author's experience, the best results are had from currents of the strength of 20 to 40 milliamperes, the polar method and central galvanization combined. Excellent results, also, are seen in the condition of soreness and swelling of joints, left after acute seizures, by labile and stabile galvanic applications. In the rheiunatic and neuralgic affections caused by tJie poison of lead, very prompt relief is afforded by galvanism ; but remedies to procure elimination of the mineral are not the less necessary. The method to be pursued in the application of galvanism is the same as in the idiopathic forms of these maladies. In the neuralgic troubles of the paludal cachexia, tempo- rary relief is afforded by galvanism ; but, as other available measures are effective in bringing about a cure, it is the less necessary to employ a mere palliative. As a means of improving the nutrition of the body in general when low from torpor of the assimilative functions, galvanism is efficient. Central galvanization, and the usual application to the cervical sympathetic and pneumogastrics, stimulate the nerves supplying the chylopoietic viscera, and thus increase the activity of these organs. The body-weight usually gains under these modes of applying the current. Messrs. Beard and Rockwell' have introduced another plan, entitled "general electrization," the object of which is to energize the various functions of the organism, and to im- prove the nutrition. The following is the method of making the applications : the feet are placed on a copper plate, one electrode ; the other electrode is passed successively over ^ Medical and Surgical Electricity, 3d ed. Wm. Wood & Co., New York. ELECTKICITY IN CONSTITUTIONAL DISEASES. 231 every part of the body, from the head downward ; and a faradic current just strong enough to cause moderate tingHng is used. Daily seances of fifteen minutes to a half hour are practised. Beard says, rather naively, that this method does not involve any exposure, as a blanket of suf- ficient size may be fastened about the throat, and under this the operator can manipulate the electrode. Although Beard's method of eeneral faradization has not been re- ceived with much favor in this country, it has been taken up by various prominent electricians in Germany, and good results have been obtained from it in neurasthenia, neuralgia, and in general in cases of debility from various causes. Weir Mitchell' proposes another method for improving the nutrition in nervous subjects, composed of massage, inunction of fat, and faradization. As these patients are not permitted to make any voluntary efforts, faradization effects that amount and decree of muscular action neces- sary. All of the muscles accessible are in turn made to contract by a faradic current every day. A distinct rise of temperature is observable when the muscles have been thus made to act, a fact in harmony with those physiological observations which have demonstrated that the principal source of heat-production in the body is in the muscular tissue. By the Mitchell method, of which muscular faradi- zation is an important part, a rapid gain in body-weight takes place. ' Fat and TMooH, and How to Make Them. 282 ELECTRO-THERAPEUTICS. CHAPTER X. ELECTRICITY IN LOCAL, OTHER THAN NERVOUS DISEASES. The electrical treatment of nasal and phar}'ngeal catarrh has been relegated almost entirely to irregular practi- tioners — so-called electricians — who find in this malady a fine field for the exercise of their arts. Independently of experience, the results of which justify me in advocating the electrical treatment of this affection, there are facts which seem to indicate the utility of faradism and gal- vanism. The influence of galvanism over the circulation, applied at any point, and of faradism, when the current can act on the vaso-motor system directly, are now well- established facts. That galvanism \\n\\ cause the absorp- tion of effusions and effect the healing of bedsores and ulcers, is equally true. The pathological changes in naso- pharyngeal catarrh including these processes, it would not seem doubtful that electricty must be serviceable. In my experience these theoretical considerations are amply justi- fied by the success of the practice. In the electrical treatment of naso-pharyngeal catarrh, certain procedures seem best adapted to bring about good results. If there be vivid redness of the mucous mem- brane, swelling, and muco-purulent discharge without solution of continuity, faradic applications are most effec- tive. If ulcerations exist and the surface of the mucous membrane is studded with enlarged follicles, more or less atrophic degeneration of the membrane having taken place, galvanism produces better results. Before apply- ing the electrodes, the passage should be cleaned by in- jecting with the post-nasal syringe a solution of common ELECTRICITY IN LOCAL DISEASES. 233 salt, or of ammonium chloride. The intra-nasal electrodes should be insulated nearly to the extremity, which should have a flattened bulbous or olive shape, and should be flexible. The other electrode, of small size and button shape, may be covered with soft leather. The intra-nasal electrode, well warmed, connected with the negative pole, should be passed along the floor of the nostril until the posterior extremity of the canal is reached, where it may rest during the application. The external positive elec- trode should be passed over the nose, resting over the ethmoidal sinus, the root and body of the nose, and on the cheeks. Strong currents are not admissible, only so strong that faint flashes are produced. The negative elec- trode is preferred for the intra-nasal application, because of its more decided chemical and catalytic effects. When faradism is employed, it is indifferent which electrode is applied internally or externally. Persistence in the treat- ment of the chronic cases is very necessary, but if carried on faithfully a sufficient time, good results may be ex- pected. In pharyngeal affections, a curved bulbous elec- trode can be introduced and applied to all parts. The current must be weak lest nausea and vomiting result. In the section devoted to galvano-caustic applications, the methods now employed in removing polypi, vegetation and other growths, will be duly set forth. Vomiting, catarrJi of the stomacJi zvitli dilatation, and atonic dyspepsia, have been treated successfully with gal- vanism by Lente,' Neftel,^ and others. The form of vomiting relieved by galvanism is the nervous, in which no affection of the mucous membrane and no indigestion are supposed to exist. Descending stabile applications to the vagi and sympathetic, and central spinal applications are ' Archives of Electrology and Neurology, i. p. 193. * Centralblatt f. d. med. Wiss., No. 21, 1877. 234 ELECTRO-THERAPEUTICS. the most efficient. A mild current only should be em- ployed. The anode should rest in the usual position in the fossa behind the angle of the jaw, and the cathode on the epigastrium, for the one form of applications ; for the other, the cathode should as before be placed on the epigastrium, and the anode on the spine, descending to a point about opposite the former. The central spinal gal- vanization to be effective requires a much stronger current, twenty to thirty elements being necessary. A great many observations have been reported, proving the efficacy of electricity in constipation and impaction of the bozvcls. Thus Basch' gives an account of a severe case of constipation occurring in an anaemic subject, relieved promptly. I have treated a number of cases of habitual constipation with success, but the permanence of the results depends on the adherence of the patient to a necessary regimen afterward. In impaction of the bowel, electricity is highly successful. Cases of obstruction due to this cause, cured by galvanism or faradism, have been published by Curci,^ Wharton, ^ Mancini,'^ Santopadre,^ Mario,^ Dutenil,^ etc. The mode of action, and the limita- tions of usefulness of the current in these cases are obvious. Contractions are excited in the muscular layer, previously in a paretic state, and the contents of the canal dislodged. This practice is eminently proper and judicious before any inflammatory reaction has taken place, but is improper if local tenderness and the constitutional state indicate the development of inflammation. In the more serious condition — invagination — faradic electricity has ef- fected cures. Bucquoy^ has given an account of three ' Wiener med. Blatter, No. 12, 1878. ^ Quoted in Virchow-Hirsch for 1877. ' Phila. Med. Times, April i, 1876. * Quoted in Virchow-Hirsch for 1876. ^ Ibid. ® Quoted in Virchow-Hirsch for 1875. ' Bull. Gen. de Therap., 30 Juillet, 1872. ** Journ. de Therapeutique, Nos. 4 and 5 for 1878. ELECTRICITY IN LOCAL DISEASES. 235 cases thus cured, Mario has narrated others, and Ballouhey' has collected twenty-two cases of occlusion from various causes cured by the application of an interrupted gal- vanic or of a faradic current. In a paper read before the International Congress at Copenhagen, Dr. Boudet stated that of fifty-seven cases treated by electricity, only sixteen were unrelieved. He preferred the galvanic to the faradic current.^ The mechanism consists in the forcible contraction of that part of the canal reached by the cur- rent, and the consequent traction exerted on the invagi- nated portion of the bowel. When a galvanic current is employed to release the imprisoned bowel, the action is probably different : from the point where the electrode is applied, a peristaltic movement is started, and this must accomplish the result by acting on the invaginated portion. One electrode is placed in the rectum, and the other is passed over all parts of the abdomen in turn, the direction of the current not being important. To these cases must be added strangulated hernia, which has been relieved when the taxis had failed. Dr. Suprunenko ^ reports a case of right inguinal hernia cured by the faradic current when strangulated and unrelieved by taxis ; Dr. Bronstein also publishes an account of a case of incarcerated scrotal hernia, in which taxis, anaesthesia, and the warm bath failed, but in which all the symptoms disappeared in a few minutes after faradization ; and Dr. Rosenhart gives still another case relieved in a few minutes by the same means. The method pursued in these cases was very simple : it consisted merely in applying the positive pole to the tumor, and passing a current of moderate strength. It is probable that one electrode to the hernial tumor and the other in the rectum would be most effective. If the faradic ' These de Paris, 1880. - Bull. Gen. de Therap., vol. 107, p. 312. ^ Several numbers of Vratch (Russian). Quoted in Virchow and Hirsch's Jahresbericht, 1881. 236 ELECTRO-THERAPEUTICS. current should not succeed it would be advisable, probably, to make use of a slowly interrupted galvanic current of considerable strength — 15 to 20 milliamperes. That so simple an expedient will relieve strangulated hernia, is cer- tainly a fact of the highest interest, and should not be allowed to lapse into oblivion. Faradism and galvanism occupy an important place in the treatment of depressed states of the respiratory and cardiac functions. The chief danger in opium narcosis is the suspension of the respiration ; by faradism this danger is overcome. Furthermore, faradism may be usefully applied as a means of irritation instead of flagellation, and is both more effective and more seemly. Indeed, faradism has become so useful in the treatment of opium narcosis, that few cases are treated without its aid. The proper mode of conducting the applications, is to apply one electrode to the spine and the other along the attachment of the diaphragm. A current of sufficient intensity should be transmitted rhythmically, to induce action in the normal time and order. Beside the muscular contraction, the irritation of the current excites voluntary breathing by a reflex impression on the respiratory centre. The same principles and methods apply in the case of poisoning by chloral, gelsemium, coniwn, curara, and the respiratory poisons in general. When dangerous symptoms arise from respiratory failure in cases of ether inhalation, fara- dism is also indicated. When the source of danger from poisons and from chloroform inhalation is failure of the heart, much less is accomplished by electricity. Indeed, mischief is often done by the untimely use of strong cur- rents. Electro-puncture has been tried, and one case is reported of chloroform narcosis in which the heart, already arrested, was made to contract again by this expedient. According to this method, a fine needle properly insulated is introduced into the substance of the heart (left ven- ELECTRICITY IN LOCAL DISEASES. 237 tricle) a short distance, and the other is placed on the parietes of the chest. Such a measure is proper only when less dangerous methods are unavailino-. The utility of electricity in the treatment of certain uterine disorders is very decided. Tripier' in France, and myself^ in this country were amongst the first to advocate o^alvanic treatment in nutrient diseases of the uterus. In cases of subinvolution, congestion without connective- tissue hyperplasia, and in chronic metritis, both faradic and interrupted galvanic applications are highly serviceable — the former because the current can be made to act directly on the vessels of the part. In cases of mcnorrhagia occur- ring in nervous subjects, I have had admirable results from galvanization of the dorsal and lumbar spine. In these cases of increased blood supply to the womb, the organ can be best treated in married women, by direct applications — a suitable electrode insulated to near its extremity being placed in contact with the womb, and the other on the hypogastrium or on the lumbar spine. Dr. Apostoli^ ]jroposes a new treatment of chronic me- tritis and endometritis, which he desicjnates " intrauterine chemical galvanocausty." To carry out this method, he in- troduces through a celluloid speculum an intrauterine stem of platinum, which he has previously sterilized by heating. This intrauterine electrode is connected with the positive pole when hemorrhagic conditions are to be treated, and the negative in all other states ; it is introduced with great care, and all force avoided. The platinum is heated gradually and slowly by a galvanic current of loo to 200 milliam- peres, obtained from Leclanche elements. When the uterus is very irritable, and the subject impressionable, he begins with a leeble current, and in all cases he increases from a ' Archives of Electrology and Neurology, vol. i. pp. 146-15S. ■■' Phila. Medical Times, vol. i. ^ Revue de Therapeutique, Sep:. 1886, p. 462. 238 ELECTRO-THERAPEUTICS. weak to a strong current — to loo, even 200 milliamperes — slowly. The duration of the application is from five to ten minutes; it must never give pain, and some hours of repose must follow it. He repeats the application every two days, and continues them for several months. A large and accumulating experience in this country and abroad, has conclusively demonstrated the power of galvanism to bring about the absorption of inflammatory exudations in the pelvic cavity. By Remak, as is else- where stated, this function of galvanism was entitled cata- lytic, but at present the term most in vogue is cataphoric. As has been shown, galvanism lessens or removes con- gestion by an influence exerted on the vessels. When the faradic current can be directly applied to the affected part, as is feasible in uterine affections, strong contractions of the arterioles can be caused by it. Whether the result, in pelvic diseases, is effected by this action on the vessels, or by catalytic or cataphoric influence, may be a merely tech- nical question ; but the important practical fact is estab- lished that by galvanic, faradic, and galvano-faradic appli- cations, very serious maladies are cured more speedily, safely, and easily, than by the best directed use of medi- cines. It seems scarcely necessary to multiply the evi- dence, but we may name in addition to the contributions of American physicians, the reports of Walcher,' Zweifel,' Apostoli,^ Fleischman,* and others, to be found in the spe- cial journals of gynecology. Remarkable results have been obtained in cases of 2iterine inertia, post-partjim hcmorrJiagc, and retained pla- centa. One electrode of the faradic battery is introduced far enough to come in contact with the womb, and the other is placed on the hypogastrium. The current should ' Centralblatt fiir die Gynakologie, 1883. * Ibid., No. 50, 1884. ^ Gazette des Hopitaux, 1884. * Fleischman : Archiv fiir Gynakologie, No. 27, 1883. ELECTRICITY IN LOCAL DISEASES. 239 be strong enough to excite firm contractions, which it will hardly fail to do. This is a more certain and scientific ex- pedient, and, also, a greatly more expeditious one than the use of ergot. In illustration of this point, may be men- tioned the case of Dr. Ramas, of Brazil, recently reported,' in which hemorrhage after abortion persisted in spite of all the remedies used, but ceased permanently after two appli- cations of faradism — one pole on the hypogastrium, the other applied to the neck of the womb. The expulsion of polypi, of moles, and of hydatids has been quickly effected by faradic applications. The cases adapted to this treat- ment are those in which the polypus lies in the distended cervical canal, those beginning to protrude held by the pedicle, and those yet in the uterine cavity, but efforts at expulsion having begun. Displacements of the uterus have been reported cured by electricity, but in these cases it is probable that the displacement spontaneously yielded on the removal of its cause. Many cases of retroversion result from subinvolution, formation of fibroids, and the pressure of neighboring organs. The first and second of these causes may be made to disappear by galvanism, and then the abnormal position may be rectified. Facts have been reported by Mann,^ Zarmini,^ and others. That chronic metritis and the development of fibroid tumors can be arrested seems probable, but certainly the facts no not warrant the assertion, that these affections can be readily cured. Patience and perseverance in the applications will doubtless be ultimately rewarded by improvement, some- times by cure. Much of the pain and discomfort caused by a growing fibroid may be relieved by galvanism. Whilst faradism is preferable in cases requiring the muscular ' Bull. Gen. de Therap., No. i. 1886. ^ New York Medical Record, April 15, 1873. ' Quoted by Virchow u. Hirsch's Jahresbericht, vol. i., 1874. 240 ELECTRO-THERAPEUTICS. action of the uterus, galvanism is preferable when nutritive changes have taken place. Electricity in Extrauterine Pregnancy. — The remark- able results that have been achieved by electrical treatment in the relief of tubal pregnancy, extrauterine or siiper-foeta- tioji, is one of the most satisfactory facts in the whole range of electrotherapeutics. The author is the more gratified at the position of this subject, in that the chief, if not the only, contributors to this method of treatment have been Ameri- can physicians, and to them is due the precise knowledge now possessed. As this work is necessarily occupied with electrical treat- ment, all questions of pathogeny and diagnosis are surren- dered to the special treatises. The diagnosis being made, and the utility of electricity placed beyond doubt, the next question is — What form of current shall be employed, both having succeeded ? The recorded experience will enable us to come to some conclusions on this point. Ur. Munde has narrated' a most interesting case in which he applied a gal- vanic current from twenty-four cells — probably the Stohrer zinc-carbon combination — and these he states were "re- cently filled," and hence were at their maximum of current strength — probably 30 to 40 milliampC'res. One electrode, terminating in a leather-covered metallic button, was placed in the rectum ; the other electrode, a large sponge, was placed over the tumor externally, and " the current was rapidly broken a dozen times or more." "The sitting lasted ten minutes, and the shocks were quite painful." It is not surprising that very considerable depression of the powers of life followed the use of such powerful opening and closing shocks. Dr. Munde reports that the patient remained very feeble and almost pulseless for forty-eight hours, after which she slowly improved and ultimately en- ' The New York Medical Record, Sept. 27, 1884. ELECTRICITY IN LOCAL DISEASES. 241 tirely recovered. During the progress of her recovery Dr. Munde also made use of faradic electricity to Insure the death of the foetus, on the sixteenth day giving a number of shocks with the full strength of a Kidder tip-cup machine, and repeating them for fifteen minutes for six days in suc- cession. In making these applications, one pole was placed against the tumor through the vagina and the other over the tumor externally, but they caused " no pain or shock whatever." By this time the patient had greatly improved in condition, the gfalvanic shocks havings succeeded in taking the life of the foetus. In some observations on this report of Dr. Munde, Dr. A. D. Rockwell,' of New York, criticises the strength of the application of galvanism. As he has had the largest individ- ual experience of any operator, and is a very distinguished electrician, his opinions are entitled to favorable considera- tion. He thinks that one-half the number of cells used — which would be twelve — and one-half the length of time would be quite sufficient. In two of his own reported cases, Dr. Rockwell used only twelve cells successfully, and no ill effects of any kind were produced. Faradism has been used with complete success in several cases and no shock followed. There is, however, a special danger from the use of a faradic current of sufficient strength — rupture of the cyst in consequence of the power- ful muscular contractions of the abdominal walls. This danger is not a consequence of the galvanic stimulation, since the muscular contractions are by no means so ener- getic. Furthermore, the galvanic current has more decided chemical action, passes through the tissues more certainly, and must be more fatal to foetal life. As when properly applied it is without ill effect on the woman, and less pain- ful, it would seem to be more useful. As both, however, ' Medical Record, Oft. 4, 1884. 16 242 ELECTRO-THERAPEUTICS. may be applied successfully, the question of convenience may also be considered. It must be admitted that, as a rule, faradic treatment will be more easily carried on. The method to be pursued in any case consists in the use of two electrodes — one a metal button, properly covered, placed in the rectum or vagina in such a position as to rest against the cyst ; the other a large, well-moistened sponge, placed over the tumor without. Slow interruptions of the faradic current and occasional anodal or cathodal opening and closing of the galvanic should be employed. The duration of the seance need not be greater than five to ten minutes. Dr. Rockwell, in the communication just alluded to, justly expresses surprise that this method of successfully treating extrauterine pregnancy is not better known and appre- ciated. About fifteen cases have been reported. Dr. Garrigues' has collected twelve in his paper, which ap- peared at the close of 1884. In November of the same year Dr. Montgomery^ reported a successful case treated by galvanism, and soon after Dr. Landis^ gave the details of a successful case in which faradism was used. Notwithstanding the unimpeachable evidence proving the complete success of the practice, Mr. Lawson Tait, of Birmingham, England, comes out with a characteristic paper in opposition and advocates laparotomy. Although this operation may become, in skilful hands, entirely safe, yet there would be no comparison between it and the simple procedure of electrical shocks. After the death of the foetus the efforts of nature are sufiicient to effect the gradual disintegration and removal of the remaining mass. AnicnorrJicea has been relieved by faradism, galvanism, and static electricity. The last has been referred to. The ' Trans. Amer. Gynecol. Society, 1884, p. 445. "^ Phila. Medical Times, Nov. 1884. ' The Amer. Jourri. of Med. Sci., Oct. 1885. ELECTRICITY IN LOCAL DISEASES. 243 form of amenorrhoea adapted to this treatment is that de- pendent on torpor of the organs. The most effective plan of making the apphcations consists in placing an electrode in or against the os uteri, and the other on the spine or hypogastrium, but in virgins both poles may be external, Amenorrhoea has, also, been effectively treated by Sir James Simpson's intrauterine galvanic stem, but this pro- cedure is not free from danofer. Before undertaking- the treatment of amenorrhoea, the practitioner should assure himself of the non-existence of pregnancy. Electricity is used with varying success in certain dis- eases of the male genito-urinary organs. In general, it may be affirmed that the results are not so good as in the corresponding maladies of the female organs. The difference is due, most probably, to the greater simplicity in structure and accessibility of the latter. Irritability of the bladder may sometimes be relieved by a weak galvanic current — one electrode resting on the spine ; the other on the perineum and hypogastrium. A more direct applica- tion of galvanism is effected by the introduction of an in- sulated sound - the extremity of metal and olive-shaped — carrying it far enough to rest in the prostatic urethra. This method may be especially serviceable when the irri- tability of the bladder accompanies chronic hypertrophy of the prostate. Under these circumstances strong currents are injurious ; from five to ten elements — often less than five — should be used. The frequent introduction of the sound is irritating, also, and by means of it germs of fer- mentation are introduced into the bladder. Having had considerable experience in the management of these cases, I am prepared to admit that the siuiDtiuin of benefit is nearly, in many cases, overcome by the disadvantages named, although it is undeniable that in other cases much relief is afforded. In some of the forms of impotence both galvanism and faradism may prove curative. In the func- 244 ELECTRO-THERAPEUTICS. tional impotence which succeeds to excesses, abstinence and faradization of the external genitals will not iinfre- quently speedily effect a cure. In these cases a marked degree of anaesthesia may exist on one side of the penis, over one testicle, or parts of both sides may be thus affected. The electric brush can be used to these anaes- thetic spots with advantage. An interrupted galvanic Fig. 86. Fig. ,87. Interrupting handle. Dr. Makenzie's laryngeal electrode. current may be highly useful — a suitable urethral electrode resting in the membranous urethra, and the other pole passing over the external genitals, A very frequent con- dition, the importance of which these tmfortunate subjects greatly exaggerate, is the following: frequent nocturnal losses ; escape of seminal and prostatic fluid on the least ELECTRICITY IN LOCAL DISEASES. 245 venereal excitement ; imperfect erections ; ejaculations on the least contact. The despondency, mental preoccupa- tion, and the feelings of moral wretchedness, which accom- pany this condition of the sexual organs, allow scarcely any other feeling or thoughts to occupy the mind, and, hence, the impaired memory, the failing attention, etc., on which they lay so much stress. The relaxed state of the ejaculatory apparatus, or the vesiculae seminales, and of the prostatic urethra, together with inadequate filling of the veins of the erectile tissue, and probably too rapid emptying of these veins by the dorsal vein of the penis, are the pathological conditions requiring correction. The mucous membrane of the prostatic urethra is also usually in an irritable and congested state. The positive elec- trode — a urethral sound insulated to within one inch of its extremity — should rest in this part of the canal, and the negative be passed over the external organs, spine, and perineum — labile descending method. If the positive electrode is kept in contact with the mucous membrane, it adheres tenaciously by reason of the electrolytic action. Faradic applications should also be made to the external parts by the brush at each stance. It is probable that the mental impression is an important factor in the curative results ; on the other hand, these subjects, striving for an unattainable ideal, are constantly disappointed and fall out with every means of relief proposed. The treatment of urethral stricture, hydrocele, varicocele, etc., pertain to the department of electrolysis, to which the reader is referred. 246 ELECTRO- THERAPEUTICS. Fig. 10 Forms of electrodes used in the various kinds of electrical applications 1. Laryngeal (Dr. Strawbridge's Eustachian 6. Interrupting handle. tube) electrode. 2. Eye electrode. 3. Tongue " 4. Ear " 5. Nasal " 7. For special nerves. 8. Large sponge electrode. 9. Uterine and rectal electrode. 10. Urethral electrode. ELECTRICITY IN LOCAL DISEASES. 247 Fig. SSa. 11. Cup-shaped for mouth of womb. 12. Vaginal electrode. 13. Sympathetic nerve electrode. 14. 15, 16. Disks, olives, points, etc. 17. Carbon electrode. 18. Wire-brush " 19. Foot-plate " 20. Spinal " PART V. ELECTRICITY IN SURGERY. CHAPTER I. ELECTROLYSIS. Definitions. — The term electrolysis signifies the decom- position of substances by the electric current. An electro- lyte is such substance, and is changed into its constituent elements at the points where the current enters and leaves the solution, whence electrodes, o6oq, a way. The elements which appear at the positive electrode or pole are electro- negative, and those which appear at the negative electrode or pole, are electropositive. Two conditions are necessary to electrolytic decomposition : the substance must be in a liquid state, and it must be a conductor of electricity. Elements or compound radicals, freed by the electric cur- rent, do not lose their chemical properties. In the passage of the current from one pole to the other, polarization of the intervening molecules is supposed to take place, and this is followed by a decomposition which frees the ele- ments, and these then enter into combination with the opposite elements of the adjacent molecules ; but at the extremity of the chain of molecules — at the electrodes — the freed elements necessarily remain uncombined, unless the metallic terminals can be attacked.' It is in this way that 1 Traite Pratique D'Electricite, etc., par C. M. Gariel, Tome premier, Paris, 1884, p. 135 et seq. 250 ELECTRICITY IN SURGERY. the conduGtion of an electric current through the fluid of the battery is explained. The quantity of any electrolyte decomposed will always be proportional to the quantity of electricity passing. This law is capable of exact determination by means of the volta- meter, an instrument already described, intended to effect the decomposition of water. When a metal in solution is the electrolyte, the amount liberated corresponds to its atomic weiofht. As the animal tissues contain substances amenable to electrolytic decomposition, it is obvious that they must yield up their component elements, in accordance with the laws of electrolysis above stated. Albumen is coagulated, salts are separated into acids and bases, and water is re- solved into oxygen and hydrogen. When the salts con- tained in the animal tissues — soda, potassa, and lime — and water, are decomposed, the acid and oxygen appear at the positive pole, and the alkalies and hydrogen at the negative. It follows that if the positive electrode be composed of metal, it will be corroded by the action of chlorine and the acids, and the negative will remain unacted on and smooth. The tissues in the vicinity of each electrode are necessarily affected by the elements brought to them in accordance with chemical laws. About the positive, the mineral acids and chlorine form combinations, and hence do not attack the tissues with the same energy as those about the nega- tive pole. If, however, the positive electrode is composed of zinc, for example, the chlorine attacking it will form chloride of zinc, a very corrosive material. This principle has been utilized to produce caustic effects at the positive pole. Although the negative electrode remains smooth, much more than at the positive, are seen there destructive effects from the action of the free alkali liberated in its neighborhood. When an ordinary carbon electrode covered with soft sponge is made to conduct a strong galvanic cur- ELECTROLYSIS. 251 rent, the skin speedily becomes reddened, and may be made to ulcerate if the contact is sufficiently prolonged. If the carbon is applied directly, an intense burning is pro- duced, and the tissues are destroyed, leaving a slough which is slowly detached, and the ulcer remaining is difficult to heal. The caustic action is due chiefly to the soda, potash, and lime. Some effect must, also, be allowed to rfie dis- association of the tissues, to the tranference from point to point of the bases, and at the negative pole to the mechani- cal action of the liberated hydrogen. The chemical action which takes place at the point where the poles are applied, has been utilized to effect a local counter-irritant action. Dr. Boudet, of Paris, has invented an instrument for this purpose. It consists of two flattened rings of metal insu- lated from each other and fastened to an upright rod or cylinder, to which is also attached a wooden or rubber handle. To each circular ring one of the battery wires can be attached, and the current passes through the skin from one ring of metal to the other — usually from the exterior rine to the interior one. The amount of irritation caused by the application of this instrument will necessarily depend on the intensity of the current and the duration of the contact. Decided redness, even vesication, may be quickly induced by it. The severe pain which attends the application will, no doubt, limit its use to the inventor.' For the purpose of electrolysis, the battery should have sufficient intensity. The zinc-carbon combination of Stohrer, for portable use. is well adapted for electrolysis, the number of elements used not more than twenty, as the electro- motive force required will not exceed the power of this combination. It is held by some of the most experienced operators (Anderson,^ Duncan, ^ Althaus'*) that heating ' Gariel : Traite D'Electricite, op. cit. ^ The British Medical Journal, 1875, vol. ii. p. 518. ^ Ibid., 1876, vol. i. p. 719. * Medical Electricity, op. cit. 252 ELECTRICITY IN SURGERY. power must, also, be regarded, and hence the larger cells of Stohrer are recommended, but this statement cannot be accepted without qualification. Smee's elements may, also, be employed for electrolysis, but Daniell's, Siemen's and Halske's, Hill's, etc., are not adapted for this purpose. The caustic battery of the Partz Electric Company, of Phila- delphia., is a very convenient and powerful machine, exceed- ingly well suited to the purpose. The battery employed by Robin' is the Gaiffe, which is composed of zinc and carbon elements, excited by chro- mate of potash solution. He advises from 40 to 60 cups, united to a pole-board with a suitable selector, so that additions can be made to the strength of the current with- out shock. Robin finds, as a result of his investigations, that the battery current for this purpose should have an intensity of 45 milliamperes. This current strength is about equivalent to that obtained from 30 Stohrer cells. As there is so much difference of opinion as to the number of cells required, the current strength should be exactly determined by an absolute galvanometer or by a suitable voltameter. Robin employs the galvanometer of Gaiffe, which has been reduced to the standard and graduated in milliamperes. Ciniselli has employed the voltameter. Robin finds that the current intensity of 45 milliamperes is equivalent to that which disengages a cubic centimetre of mixed gases in two minutes in the voltameter. Any of the elements mentioned above may, therefore, be used in electrolysis if their performance is ascertained by a standard galvanometer. In the absence of these scientific appliances, an operator is not helpless. The current strength may be ascertained in a practical way, by testing the needles in some white of eg-a-. Robin finds that a current strength of 45 milliamperes is sufiicient to cause ' De I'Electro-puncture dans la Cure des Aneurysmes intrathoraciques, etc. These de Paris, 1880. ELECTROLYSIS. 253 Fig. Sg. coagulation of the albumen in twenty to thirty minutes. This, then, becomes a practical test of ready application under all circumstances. Some electrolytic separation takes place when the ordinary gas-carbon or brass electrode covered with sponge or soft leather is applied ; but for electrolytic purposes, a special arrangement is necessary. As the morbid material to be acted on lies often to a considerable depth beneath the skin, a needle is necessary, and as the sound tissues must be saved from damage, the needle should be insulated to within a half inch of its extremity (Fig. 91). The length of the needle will vary with the purpose to which it is applied, but usually they are from two to four inches in length. The smaller the better, consistent with the necessary strength. Ciniselli, Anderson, Dujardin-Beaumetz, and Robin strongly insist on this point. The diam- eter may be stated as between one-twelfth and one-sixteenth of an inch — or smaller or larger than this, as may be most suita- ble under the special circumstances. If too small, the needle may be destroyed by electrolytic action, or break as it is being introduced. To prevent oxidation, the uncoated part should be gilded. The insulation is extremely im- portant ; if defective, the current is deflected, the sound textures are burned, and hence the electrolytic action is inefficient. Various kinds of coatino- are recommended to secure proper insulation. Shellac, hard rubber, vulcanite, etc., are used. Hamilton' advises the following, which he has tested in actual use. As it seems to the author a good preparation, it is given for the benefit of those who box of needle electrodes. ' Clinical Electrotherapeutics. New York, D. Appleton & Co., 1875, p. 140. 254 ELECTRICITY IN SURGERY. may be unable to obtain the needles prepared by a com- petent dealer : Gum shellac (brown) one drachm. Squibb's solution of India-rubber, one and a half drachms. Wood naphtha, two drachms. Mix. With this solution, the needle is coated by successive additions of a thin layer, each one permitted to dry thoroughly before the next one is put on. When suffi- cient coatine has been laid on, it is rubbed down with the finest emery paper, and a final layer or two are then added to impart the necessary smoothness. The cutting end of the needle should be lancet-shaped, or triangular, to facili- tate transfixing of the skin, for a merely sharp needle will pass through the skin with difficulty. Each needle should have a short flexible insulated wire attached for con^ venience of manipulation, and four to six needles should be fastened to a handle arranged as the ordinary electrode handle, for adjustment to the poles of the battery. Dealers in medical electrical apparatus now furnish these needles, ready for application. Aneurism. The Operative Procedure. — There are important dif- ferences of opinion, and, also, of practice, in regard to the details of electrolysis as applied to the treatment of aneurism. The kind of elements and accessories, and the structure of the needles have been described. It is. necessary now to determine the electrode to be inserted, the time to be occupied in the process, and the manage- ment during and subsequent to the operation. Both poles induce coagulation. The clot formed at the positive is. comparatively smaller, firmer, and more closely attached ; whilst that at the negative pole is larger, softer,, and looser ELECTROLYSIS IN ANEURISM. 255 in its attachment to the parietes. The needles are dif- ferently affected — the positive being- roughened, oxidized, and attached, the negative smooth, untouched, and readily withdrawn. Ciniselli, who has had a largfe measure of sue- cess and abundant experience, inserts the poles in alterna- tion, Robin introduces the positive pole within the sac only, whilst the negative is placed at some indifferent point on the integument. The reasons assigned by Robin for preferring the positive pole to induce coagulation, are the following : The clot about the positive is firmer and more strongly adherent ; the accumulation of hydrogen in the clot about the negative pole tends to disassociate the coagulum, and the gas, also, distends the aneurismal parietes, and local inflammation, suppuration, and sphacelus are more apt to occur about the negative than the positive. These reasons appear to us to be conclusive. There, is, however, one objection to the positive electrode. The needle is so firmly imbedded in the clot and in the walls of the sac, that it is difficult to withdraw without disengaging clots or caus- ing hemorrhage. The positive needle must, therefore, be withdrawn with great care. Robin recommends an instru- ment for this purpose ; but by careful lateral pressure, and a delicate rotary motion of the needle, it can be withdrawn without accident. The number of needles inserted into the aneurismal sac will depend on its size. From one to four needles are inserted in the most prominent part of the tumor, and about an inch and a half in depth, so that the movement of the blood current will impart to them a beat synchronous with the cardiac systole. The positive pole is connected with each needle in turn, and the current transmitted begins at the minimum, is raised gradually to the maximum, and after some minutes is slowly reduced and shut off. The duration of the current is about twenty minutes, but 256 ELECTRICITY IN SURGERY. this time varies with the battery, and especially with the condition of the blood in the aneurismal sac. The needles should be removed in the order in which acted on, and with great care and gentleness. The patient should be recumbent during the operation, and should remain in a condition of absolute repose for some hours subsequently. The negative pole should consist of a large, well-mois- tened sponge, placed on the shoulder or side. The ope- rator should be careful to pursue the order in the various points of manipulation above indicated. Accidents. — If the proper strength of current is used, if the needles are well constructed, and if all the details are carried out efficiently, yet gently, no accidents are to be apprehended. If the current has too much heating power, as happened in one of the cases reported by Dr. Henry Simpson,' sloughing along the track of the needles, and sudden, fatal hemorrhage may be thus produced. If the power is insufficient, coagulation will not be effected. In withdrawing the needles, rarely on introducing them, coagula may be separated, carried into the circulation, and distant vessels be occluded. The symptoms resulting will depend on the vessel or vessels blocked. If the aneurism be situated on the ascending aorta, an embolus may enter the left carotid, rarely the right, and produce the phe- nomena of apoplexy, followed by right hemiplegia and aphasia. The same result might follow if the aneurism were at the arch. If situated on the innominata, the symp- toms resulting would be those of apoplexy, followed by left hemiplegia without aphasia, or the subclavian or brachial blocked, the right arm would suddenly become intensely painful, cold, and weak. Occlusion of certain of the ab- dominal arteries, or of the femoral, would be produced by clots detached from an aneurism of the descending aorta. ^ London Lancet, supra. ELECTROLYSIS IN ANEURISM. 257 Fortunately, these are comparatively rare accidents, and Still less common are the phenomena due to multiple embolisms. In withdrawing- the needles, hemorrhage may occur. This will not happen unless the needles are too large, are too much heated, or are roughly handled. Owing to the condition of the tissues, slouehino- mav occur some hours or days after the needles have been withdrawn, and then a profuse hemorrhage terminate life. Or an inflammation of the sac and its contents may follow the process of elec- trolysis. This accident will be announced by chills, fever, increased pain, etc., and death occurs suddenly by the yielding of the sac. Curative Results. — When ck)ts form about the needles, the coagulation extends until finally an organized clot fills the sac. At first, some heat and tenderness are felt about the sac — a trivial inflammation which soon subsides under the action of cold-water applications. The tumor becomes firmer, shrinks in size, the pulsations diminish, and, finally, disappear, and at last a hard knot, merely, remains at the site of the aneurism. It should not be understood that a process of decomposition is effected by the needles. The sole purpose of their introduction is to bring about a coag- ulation of the blood, and it is to the organization of the clot that the cure is to be attributed. Thus, by the elec- trolysis of an aneurism, the same result is sought to be accomplished as by the other medical and surgical ex- pedients. Clinical Experiences. — Petrequin,' of Lyons, seems to have been the first to apply the method of electrolysis to the treatment of aneurism, his first case beino- an aneurism of the temporal artery, traumatic in origin. In the four years from 1845 to 1849, ^^^ gained in experience and per- ' Bull. Gen. de Therap., tome xxxi. p. 65. 17 258 ELECTRICITY IN SURGERY. fected his method, die result being given in an important monograph which appeared in the latter year. Whilst Petrequin was engaged in these clinical researches in Italy, a medical commission composed of Stambio, Guag- hino, Tizzon, and Restelli, studied in animals the power of the electric current to cause coagulation of the blood. These experiments demonstrated that, although the nega- tive pole possesses but little coagulating property, the positive, on the other hand, forms a coagulum, at first in- complete, but becoming in a short time solid enough to close an artery of the size of the carotid,' These expe- riences formed the basis of the method of treating aneu- risms devised by Ciniselli, which consisted in the employ- ment of the electric current to coagulate the blood in the aneurismal sac. The strength of current necessary was ascertained by the amount of water decomposed within a given time. The first needle introduced into the sac was connected with the positive pole, whilst the negative was placed near the aneurism externally ; after five minutes he replaced the positive pole by the negative, and the former was then connected with the second needle, also introduced into the sac ; after another period of five minutes the nega- tive pole was connected with the second needle, and the positive transferred to a third needle ; and thus on, each needle being made to pass alternately the current from the positive and negative poles respectively, always begin- ning with the positive. Treated in this way, of thirty- eight cases, a radical cure was not obtained in one, although in twenty-seven the cases were so far ameliorated that they were able to resume more or less fatiguing occupation for some months or years. Since the publication of Ciniselli's method and its results, a great many cases have been reported from Italy. In Germany, Fischer (Franz) f in ^ Ibid., tome 93, p. i et seq. Paper by Dujardin-Beaumetz. * Berliner klin, Wochenschrift, No, 45, 1874. No of cases. Cures. Deal 37 6 3 13 3 6 2 I 29 16 3 8 6 89 32 12 ELECTROLYSIS IN ANEURISM. 259 France, Bernutz, Broca, Dujardin Beaumetz,' and others; in England, Anderson,^ Duncan, ^ Bastian, Clifford Allbutt; in this country, Sands," Lincoln, Keyes,' and others, have also reported cases, so that now the experience gained may enable us to arrive at definite conclusions. In a lecture "On Electrolysis," Dr. Duncan, of Edinburgh, has given a tabular statement of the cases of aneurism treated by this method to 1879 (May).^ His figures are as follows: Aorta Innominata, carotid, and subclavian External iliac Femoral, popliteal, and brachial Smaller vessels . . _ . Totals .... Since the period included by Dr. Duncan, I have col- lected the following cases : Case i. — Aneurism of ascending aorta. By Guisseppi Bulgheri, Gaz. Med. Ital. Loinb , No. 13, 1876. Referred to by Virchow u. Hirsch's Jahresbericht for 1876. S.ic of the aneurism consolidated, reduced in size, and apparently cured. Treated by the method of Ciniselli. Cases 2 and 3. — Ibid. Same result in the second, but only improvement in the third case. Virchow u. Hirsch's Jahresbericht for 1877 contains an abstract of the three cases. Case 4. — Aneurism of the innominata. By Carlo Gallozzi, // Morgagni, Settr. •1876, p. 585. Quoted by Virchow u. Hirsch's Jahresbericht for 1876. Electrodes applied externally, one on the tumor, the other adjacent. The current from eight elements of Leclanche was directed to the tumor for eleven minutes at a time. Five or six seances were had each day, and for eight days, a considerable diminution in the size and firmness of the tumor being the result. Case 5. — Aneurism of the left subclavian. By A. Martins, Ibid. The result was negative. ' Bull. Gen. de Therapeutique, July 15, 1877. '■* McCall Anderson, British Med. Journal, 1875, vol. ii. p. 517. 2 Ibid., 1876, vol. i. p. 619. * New York Medical Record, May 15, 187 1. ^ New York Medical Journal, July, 1871, p. 3. *^ Brit. Med. Journal, 1876, vol. i. p. 620, op. cit. 260 ELECTRICITY IN SURGERY. Case 6. — Aneurism of the aorta. Dr. John Romans, No. i6, 1876, of the Boston Medical Journal. The treatment by electrolysis was a failure. Case 7. — Aneurism of the aorta. Dr. Dujardin Beaumetz, Bull. Gen. de Therap., Juillet 15, 1877. Very considerable improvement in the condition of the patient was the result. Case 8. — Aneurism of the aorta. Guimarez Pareira, Gaz. des Hopitaux, 81, 1876. Reported " cured." Case 9. — Aneurism of the aorta. Dr. H. Bowditch, Boston Medical Journal, No. 2, 1876. The case was much improved. Case 10. — Aneurism of ascending aorta. Dr. Henry Simpson, The British Medical Journal, vol. 2d for 1877, July 14. Failure. Case ii. — Aneurism of the aorta and innominata. The same reporter and source as No. '10. In this case the result was more favorable for a time; the tumor was greatly reduced in size and consolidated, but electrolysis was again employed with a battery furnishing more heating power. Suppuration ensued in the track of the needles, and the aneurism was laid open, death ensuing by hemorrhage. Case 12. — Aneurism of the aorta. Mr. H. L. Brown, The Lancet, Oct. 26, 1878, p. 584. A large tumor was apparently consolidated by two needles connected with the positive pole, and a cure was supposed to have been effected. The man, escaping from the hospital and taking no precautions, sufTered a relapse. Cases 13, 14, and 15.— Three cases of intrathoracic aneurism. Dr. Gregor Ottoni, Annali utiivers di vied., Nov. 1878, p. 442. Quoted in Virchow's u. Hirsch's Jahresbericht for 1878. The method of Ciniselli was pursued. In two the results were negative, but in the third very great improvement resulted. Case 16. — Aneurism of the ascending aorta. Dr. Bucquoy, L Union Medi- cale. No. 20, 1879. Treated by Dujardin Beaumelz's modification of Ciniselli's operation, with a very favorable result. Cases 17, 18, 19, and 20. — These cases of intrathoracic aneurism, treated in this country by Drs. Sands, Lincoln, Keyes, and Pepper, were probably not included in the report of Dr. Duncan. In these cases improvement was the usual result, but no instances of actual cure occurred. Case 21. — Aneurism of aorta. Dr. Ord, St. Thomas's Hospital Reports, New Series, vol. x. Since the last edition of this work, the author has seen reports of five additional cases. Only one, which was from Italy,' was reported cured; in two^ decided amelioration 1 Dr. F. Braucaccio : Rivista Internaz. di Med. e Chirurg., February, 1884. The Practitioner, vol. 33, p. 132. 2 Dr. Salvia (Brazil): London Med. Record, May 15, 1886. Two needles, positive pole, thirty-five minutes. Right subclavian. Also, Dr. Machado's case. Ibid., May 15, 1885. ELECTROLYSIS IN ANEURISM. 261 followed the operation, but in the others harm rather than benefit resulted. It seems needless to occupy space with the details of these cases. A review of the subject affords not much encouragement for the future success of the method of electrolysis in the treatment of intrathoracic and abdominal aneurisms. We are not yet in a position to give accurate results. In most of the cases reported "improved" or "cured" the condi- tion of the patient subsequent to the immediate results of the operation is not known. This is especially true of the Italian cases. The cures reported in some instances are so extraordinary that we may well entertain doubts about their permanence. The best results have been obtained by the Italian operators using the method of Ciniselli. This, as modified by the French operators, promises to be the method of the future. There are yet differences of opinion as to the form of battery best suited for this purpose. Anderson' says the battery should "have large cells to in- crease the chemical effects." On the other hand, in one of Simpson's cases, an untoward result, when the promise of success was bright, resulted from a change to a battery of larger cells, suppuration occurring in the track of the needles. The intensity should be great rather. I have already indicated the degree of intensity necessary. When an absolute galvanometer, graduated in milliamperes of current strength, is provided the operator, an exactness of results may be arrived at hitherto unattainable. To this our efforts should now be directed. In view of the remark- able success which has attended the use of the iodides in the treatment of aneurisms, there is little inducement to employ a method which accomplishes so little and is, at the same time, so complicated and troublesome. Numerous cases of cirsoid aucitrisiu have been reported ^ The Medical Times and Gazette, 1875, vol. ii. p. 516. 262 ELECTRICITY IN SURGERY. cured. Typical examples have been published by Mr. Hulke.^ In cystic tunioi's, cystic degeneration of the tJiyroid gland, and eclmiococci of the liver, very admirable results have been obtained from electrolysis. Cystic tumors of the neck have been reported cured by Amussat,^ Ultzmann,^ and others ; cystic bronchocele by Smith/ Althaus/ and others. Both needles are introduced and kept near each other, and the current is allowed to flow until the contents are in part decomposed. Very promising results have been obtained by Seme- leder^ and Clemens^ in the treatment of ovarian cysts by electrolysis. Fieber^ failed in an apparently favorable case. This method of treating ovarian cystic tumors deserves more attention than it has hitherto received, not- withstandinor the remarkable success which has attended abdominal section. Unilocular cysts with simple contents are more favorable than the multilocular cysts with com- pound contents. The treatment should be undertaken early, before the tumor has attained a great size. The method of procedure is simple. The needles must have the requisite length, and be carefully insulated. The tumor, well depressed into the iliac fossa, must be steadied before the needles are inserted, and the intestines must also be pushed aside. The needles should penetrate one or two inches into the cyst, and their points made to approximate within an inch, to lessen the resistance. The duration of the application depends on the character of the fluid to be decomposed, and may be stated as from fifteen minutes to one hour. ' Ibid., June 9, 1877, p. 612. '^ Bull. Gen. de Therap., Oct. 15, 1872. ' Wiener med. Presse, Nos. 42, 43, 44, 46, 1876. * New York Med. Record, Aug. 7, 1875. ^ British Med. Journal, 1875, "^ol- ''• P- 605. ^ Wiener med. Presse, loc. cit., Nos. 50 and 52. '' Deutsch. Klinik., Nos. 6 and 7, for 1875. * Wiener med. Presse, supra. ELECTROLYSIS. 263 Solid tumors, as goitre/ enlarged submaxillary glands,^ subcutaneous erectile tumor,^ and nasal polypi/ and similar growths have been repeatedly cured by electro- lysis. Good results, although it cannot be affirmed that any cures, have followed the electrolysis of uterine fibroids. The galvanic current, made to traverse these growths, has a most beneficial effect on the condition of the patient ; it relieves pain, diminishes the accompanying congestion, and retards the growth. Polypi, ncevi, sebaceous tumors, and similar new formations are promptly cured by electrolysis. In strictu7^e of the urethra, remarkable results have been obtained by Newman, ^ Tripier,*' Frank,^ and others. Veiy lately professional attention has been directed anew to the subject by the success obtained in London by Mr. Steavenson, and Mr. Bruce Clark. The author of the method, Dr. Newman,^ of New York, has, in a recent communication, stated anew the steps of the procedure, and has explained the causes of the failures. In so doing, he has quoted from letters of inquiry received from practi- tioners, who exhibit in their questions and comments, phenomenal ignorance of the simplest points in the physics of electricity. He enumerates amongst the causes of fail- ure, "incompetence of the operator," "mismanagement," "mistakes of diagnosis," "faulty instruments," etc., but according to him, " with care and good management, failures are the exceptions," an opinion in which the author fully coincides. If success so commonly attends * Wahltuch : Med. Times and Gazette, Jan. 28, 1877. * Davis : Phila. Med. Times, Oct. 2, 1871. ^ Archives of Electrology and Neurology, vol. ii. p. 74. * Bruns : Berliner klin. Wochen., Nos. 27 and 28, 1872; 32, 1873. ^ Archives of Electrology and Neurology, vol. i. p. 18. ^ Ominus et Legros, op. cit, ■' New York Med. Record, Feb. 2, 1874. * New York Med. Record, Sept. 25, 1886. Is Electrolysis a Failure in the Treatment of Urethral Strictures? Pamphlet. 264 ELECTRICITY IN SURGERY. this method of treatment, it is important to have every detail of the operative procedure clearly established. The negative electrode only is to be brought into com- munication with the stricture. The instrument which forms the negative electrode is a conical or egg-shaped bulb of metal attached to an insulated sound or director, and it has a curve that is "short" rather than long. Before turning on the current, the urethral electrode is placed in position resting against or introduced into the stricture, but no force is used and no pain should be given. As the current passes, the bulb should be passed into the strictured part, and through it, if this can be done without violence. Not more than one electrode should be passed during one sitting. The strength of the current used will depend somewhat on the susceptibility of the patient, but as a rule, not more than three to five milliamperes — equal to two to five (2—5) elements or cups — need be used in any case, and for a period of time not to exceed fifteen minutes. Acute inflammation, or, indeed, any decided irri- tation is a contra-indication to the use of the instrument, and that canon which requires that no pain be inflicted, should not be violated under any circumstances. The frequency with which the operation is done will depend somewhat on the character of the case, but more on the effect of the preceding application. Fcstina lcntc\ is a good maxim in the process of electrolysis of stricture. " Weak currents at lono; intervals, '' is the dog-ma enun- ciated by Dr. Newman. Electrodes of various sizes and shapes, tunnelled as required, are necessary in the treatment of various forms of strictures. Besides the special electrodes, all the appli- ances used to detect the stricture and fix its position must be used. The ordinary manual dexterity essential to the treatment of stricture must be possessed by the operator, ELECTROLYSIS. 265 for it cannot be replaced by a mere facility in the use of electrical apparatus. Closely related to the subject of the electrolytic treat- ment of stricture, is the new method of removing hyper- trophy of the prostate gland, and other morbid states, as devised by Dr. Newman; but for the details of the method, and for the maladies for which applicable, the reader is referred to the next section, treating of electric lighting and heating. Netfel,' of New York, and Mussey, of Cincinnati, report cases of malignant disease (apparently) which were made to disappear by electrolysis. The growths so decomposed appeared to be examples of epithelioma ; but as these results have not been confirmed by others, it is generally held that errors of diagnosis were committed. Beard,'' who has had encouraging experience in the treatment of malignant disase by this method, proposes a new plan, which he entitles "working up the base." According to this, the sound tissues immediately subjacent to the tumor are transfixed by the needles, and the source of supply to the new formation is thus acted on. Rockwell^ reports good results from Beard's method in a case of cancer of the breast. I have had remarkable results in the treatment of those fibroid tumors of the breast which are so often associated with displacements and other diseases of the uterus, and accompanied by neuralgia of the cervical plexus. I have in these cases used labile and stabile applications to the nerves and to the breast, but have not introduced elec- trolytic needles. Of six cases thus treated, four were cured, and in the others the time was insufficient. Electrolysis has been proposed and employed in a few ' Virchow's Archiv, vol. Ixx. p. 171. ^ Archives of Electrology, etc., vol. i. p. 74. •'' Archives of Electrology and Neurology, loc. cit. 266 ELECTRICITY IN SURGERY. instances as a means of arresting the development of the foetus in cases of extrauterine pregnancy. Although an effective means, it involves more pain, danger of rupture from the accumulation of hydrogen in the sac, and subse- quent peritonitis from the punctures, than the simple method now pursued, which has been fully described under electrolysis. In his remarkable way of settling things, which has become a chronic habit with Mr. Lawson Tait, he has taken ground against electrolysis, and of course in favor of laparotomy. To follow his mode of expression — he is apparently totally ignorant of what has been accom- plished by galvanism and faradism in cases of extrauterine pregnancy. Excellent results have been obtained by electrolysis in hydrocele, by Rodolfi,' who first proposed it, by Erhardt,^ Frank, 3 and myself. In the treatment of this affection, two insulated needles, connected with the electrodes, are intro- duced into the sac, and their points are brought within a half inch of each other, when the current is turned on. Decomposition ensues, according to the laws of electro- lysis, and absorption takes place. Rodolfi reports eight cases, with the following results: three were radically cured, two required a second operation, and three were failures more or less complete. ^ Virchow u. Hirsch, Jahresbericht for 1872. ^ Ibid. ' Archives of Elect., loc. cit., vol. i. p. 170. MEDICAL ELECTRIC HEATING AND LIGHTING. 267 CHAPTER II. MEDICAL ELECTRIC HEATING AND LIGHTING. GaLVANO-CAUTERY AND LaMPS. Electrical drscharge takes place, as has been set forth, by conduction, by convection, and by disruption. In the ordinary appHcation of galvanism, the electricity passes from one electrode to the other by conduction. If, for the usual electrodes needles are substituted, and they are separated by a greater or less interval, the solids or fluids acted on are decomposed into their constituent elements. The process of discharge is then by convection, and it is designated, in the language of Faraday, electrolysis. Al- though here the needles are not in actual contact, there is a route of communication — the solid or fluid into which the needles penetrate — by which the current passes. Although the general principles governing the produc- tion of luminous effects by electricity have been set forth, it is necessary now to enter into the consideration of cer- tain practical details. The electrical current passing from the higher to the lower potential through the connecting or conjunctive wire, always produces some heating effects and the temperature of the wire rises somewhat. The degree of heating de- pends on the diameter of the wire. If the wire is small, the heating becomes perceptible. Joule, the English phy- sicist, has formulated two laws, which govern the result. I. The quantity of heat developed in the unit of time by the passage of an electric current in a conductor, is in pro- portion to the resistance of the conductor ; and, 2, is in proportion to the square of the intensity of the current. 268 ELECTRICITY IN SURGERY A galvano-caustic apparatus consists essentially of two parts: the battery for producing- the current ; the cautery proper, which is a platinum wire in some form heated by the current. The current-producing mechanism may con- sist of a special arrangement of the elements, or of an accumulator. Various forms of battery have been devised and are now in use, but the system of secondary, or storage batteries, or accumulators, is becoming popular, because of their convenience and uniformity. Several forms of Fig 90. galvano-caustic batteries are exhibited in the accompanying illustrations. They consist for the most part of zinc-carbon elements, excited by bichromate of potash solution. They have a few large elements, or a number of small elements connected together ; or, as it may be termed, " arranged for quantity." The principles are the same, what form soever the combinations may take. The caustic battery MEDICAL ELECTRIC HEATING AND LIGHTING. 269 first devised was that of Middledorpf, described in his classical work on Gahano-causty in Operative Medicine, published at Breslau in 1854. On the continent the com- binations of Bunsen and Stohrer, in France Bunsen's, and now Trouve's, and in England Stohrer's modified by the local dealers, are the forms in use. In this country the battery of the Galvano-faradic Company, Piffard's, Byrne's, the Partz Company's (Fig. 91), Queen's (Fig. 92), and others, are those employed. The first named is composed of large zinc-carbon elements (Fig. 90), immersed in a bichromate of potash solution, which is kept agitated by the bellows to prevent polarization and to maintain the chemical activity. Piffard's battery is composed of large zinc-carbon elements, which are contained in cells of vul- canite, and can be suspended on a movable arm screwed into the box. When lowered into the fluid, the top of the elements, which is made of hard rubber, contains two lateral bars supporting them, and which permits a rocking motion to keep the exciting fluid agitated. This is a more efificient combination than that of the Galvano-faradic 270 ELECTRICITY IN SURGERY. Manufacturing Company. Still more effective is the battery of Dr. Byrne (Fig. 91), whicli consists of small elements united for quantity, thus opposing a larger surface to the action of the exciting fluid than can be effected by merely large plates. This battery consists of zinc-carbon cells in a case six inches long, nine inches high, and five inches Fig. 92. Queen's caustic battery. wide. Each plate is composed of a number of smaller ones so united as to constitute one, and all are contained in one jar. They are also placed in close juxtaposition, from the one-sixteenth to the one-eighteenth of an inch apart, thus diminishing the internal resistance. The suc- cess of Dr. Byrne's battery strongly supports the accuracy MEDICAL ELECTRIC HEATING AND LIGHTING. 271 of that theory which ascribes superior activity to the small elements combined for quantity. The storage cells may •be used for this purpose also. Messrs. J. W. Queen & Co. have a convenient and easily worked cell, which has a treadle attachment, and which is used by them for running an electric motor (Fig. 92). The conductincr wires should have sufficient size to offer the least resistance to the passage of the current, and should be as short as is compatible with their usefulness. The platinum electrodes are of various forms, for adapta- tion to the conditions present. On page 272 are repre- sented the knives, cauteries, loops, etc., employed in this branch of surgery (Fig.93 ). The knives are variously shaped, so as to be useful lor cutting, scraping, or gouging. The loop is attached to a ratchet-wheel, by the revolutions of which it is equably shortened as it cuts throuo-h the tissues. The "dome cau- tery" consists of a spiral of platinum wire wrapped about a porcelain button. When the wire is rendered hot, the porcelain is heated correspondingly. Before undertaking an operative procedure, the condi- tion of the battery must be ascertained. It must be in good working order, of course, and all of the necessary appliances at hand. The amount of electricity required will be determined by the size of the wire or knife to be used, and the amount of tissues to be cut through. This may be closely approximated by trying the knile or wire on a piece of meat. The depth to which the elements are immersed, or the number of elements required to produce a given quantity of electricity, once known, it would seem a needless refinement to try the strength of the battery each time, but experience has shown that it is preferable to do so. If the quantity is too great, the wire may be melted ; if too little, the operation may have to be sus- pended. The wire must be incandescent. If it cut through 272 ELECTRICITY IN SURGERY, Fig. 93. MEDICAL ELECTRIC LIGHTING AND HEATING. 273 too quickly by reason of too great heat, there is danger of hemorrhage; if too slowly, the surrounding parts inflame. The advantages of the method are numerous and impor- tant, and the pain which attends the operation is not great, and may be almost wanting. Shock is less than by other methods. If the wire be at the right temperature, there is no hemorrhage, the vessels being effectually sealed as the operation proceeds. It follows that the electric knife may be used in positions where the ordinary cutting or tearing operations could not be performed. The loop, cautery, or knife is placed in position first, and then heated to the requisite point, and is cooled again before withdrawal. In general, it may be stated that galvano-causty is applicable to the removal of growths from internal cavities, of cancer in any accessible situation, and of morbid products where hemorrhaore is to be feared. The more abundant the experience (Dr. Byrne, Dr. Bryant), the more decided the approval of the method. The great obstacles to the de- velopment of the method are the care and time requisite for the management of the battery, and the failures which may take place at a critical juncture in the best hands. In setting forth the work done in the field of galvano-caustic surgery, it will be most convenient to treat of the maladies requiring the loop, the knife, and the cautery. The Loop. — Before the loop is used in any case, it should be carefully tested on a piece of meat of a size correspond- ing to the growth to be removed. If the external integu- ment is embraced in the tissues to be divided, it is better to cut a groove with the platinum knife at white heat, in which the wire may be placed. The wire should be of a size adapted to the work to be done, and the battery should be capable of heating the wire to the necessary point, and maintaining it there during the time required. The wire should be put in position before turning on the current, and the ratchet-wheel should be slowly worked, giving 27-i ELECTRICITY IN SURGERY, ample time for the division and searing of the tissues. Obviously the caustic loop is adapted to the removal of deep-seated /(9/)/// in the nose, ear, larynx, uterus, rectum, etc. In his elaborate work on galvano-caustic, Voltolini' reports a large number of cases of polypi of the larynx, nose, and ear, easily, quickly, and safely removed by the loop. Amputation of the neck of the uterus has been per- formed in the most satisfactory way by Whittaker,- Byrne,'* and others. No one has applied himself more thoroughly to the galvano-caustic operative methods than Bryant,^ and he reports various examples of amputation of the tongue, penis, and of hemorrhoidal tumors, accomplished in the most admirable manner by the galvano-caustic loop. It would se'em needless, indeed, to multiply the references to this method. On all hands it is rei/arded as the most efh- cient, and at the same time safest method, for, while no blood is lost, no shock is experienced. In the operation for the removal of a polypus from the cavity of the larynx, the patient must be trained into a proper tolerance of the instruments. The application of the loop is, of course, guided by the mirror, A long, properl)" curved, double canula, with the loop attached is necessary, and this is fixed to the handle with its ratchet- wheel or screw for drawing on the wire. The loop as guided by the mirror is thrown over the polypus, then the current is turned on. and in a short time the pedicle is severed. If the loop is at a white heat, the division of the tissues is accomplished too speedily, and hemorrhage may result, Mr, Bryant advises that the wire be main- tained at a dull red rather than a white heat. In the 1 Die Anwendung des Galvanokaustik im innern des Kehlkopfes und Schlundkopfes sowie in der Mund- und Nasenhohle und den Ohren, etc.. von Rudolph Voltolini, Wien, 1872, p. 317, ^ The Cincinnati Clinic, Sept. 1872. ^ The Electro-cautery in Uterine Surgery, New York, 1874. * Chnical Lectures on Bloodless Operating. The Lancet, Feb. 28, 1874. MEDICAL ELECTRIC HEATING AND LIGHTING. 275 operation for removing a polypus of the auditory canal, or of the nose, suitable specula and loops are required, but the form of handle may continue the same. In the case of hemorrhoidal tumors of the rectum, the procedure is as follows : The tumors are drawn down and held by a tenaculum or sing-le or double hook if in a position to be so secured, with or without the previous adjustment of a Sims's speculum ; the loop is passed over the tumor and pressed well down to its base or point of attachment, and at the same time tightened to prevent slipping ; the wire is heated to a dull red, and made to cut its way through slowly to avoid after-hemorrhage. In regard to the operation for the removal of the tongue by the galvanic loop or ecraseur, Mr. Bryant expresses himself as follows :' "There are no operations of importance that the sur- geon has to perform which have been more benefited and simplified by the introduction of the galvanic cautery than those upon the tongue ; for there are none in which, with- out its use, hemorrhage is more troublesome or dangerous, and there are none with its use which more satisfactorily exhibit its bloodless character. Indeed, before the intro- duction ot the galvanic cautery or ecraseur, operations on the tongue were very rarely performed." Jn the same lecture he further says : "By the use of such instruments carefully employed, no fear of bleeding need disturb the mind of the operator ; and what was formerly a very serious measure has become comparatively a simple one." Again he remarks: "I will say again what I have said before, that, of all ways, the removal of the tongue by the galvanic ecraseur is the one to be adopted." In the per- formance of the operation for amputation of the tongue for cancer, Bryant directs that the diseased part be isolated * The Lancet, loc. cit., Feb. 28, 1874, p. 291. 276 ELECTRICITY IN SURGERY. by passing beneath it through the healthy tissues some long pins, ivory pegs, or curved needles in handles, and the loop passed behind the pins, the tongue being well drawn forward and firmly held, and the mouth kept open by a suitable gag. He further directs that the wire of the loop be "thick or twisted," his preference being for the twisted wire, and that "it should not be heated beyond a red heat, and the redness ought to be of the dull kind. Above all, the process of tightening should be very slowly performed, the wire of the ecraseur being screwed home only as it becomes loose by cutting through the tissues." In the lecture from which I have quoted, Mr. Bryant reports eleven cases of cancer of the tongue thus oper- ated upon, and he concludes that "the removal of a tongue wholly, or in part, for cancer is a justifiable proceeding, and that the sooner the operation is performed after the diagnosis of the disease has been made, the s^reater are the prospects of a long immunity from the disease, or a complete cure." Mr. Bryant also reports cases of amputation of the penis for cancer, in which he highly commends the blood- lessness and the freedom from pain of the galvano-caustic loop. His lecture includes fibro-cellular tumors of the labia, epithelioma of the lip, etc. When the growth is without a pedicle, he isolates it by passing pins or acupunc- ture needles beneath it, and thus confines the wire to its proper course. The Knife. — No one has used the galvanic knife more, nor carried its applications to greater perfection, than Dr. Byrne,' of Brooklyn. He has especially attained to un- equalled success in the treatment of uterine cancer, employing the knife and scrape, and carrying the incisions deep enough to insure the removal of all the diseased ' Electro-cautery in Uterine Surgery, loc. cit. MEDICAL ELECTRIC HEATING AND LIGHTING. 277 parts. The advantage of the galvanic knife consists in the freedom with which it may be used without the production of hemorrhage. The platinum knife can be shaped to any desired form. It should be put into position before the heating begins, and cut slowly, giving ample time to secure closing of the vessels. One of the most brilliant operations ever performed with the galvanic knife is that described by Dr. Gaillard Thomas/ of New York. It was a case of tubal pregnancy, the cyst being reached through the vaginal roof. Dr. Thomas employed the platinum knife heated to a white heat, and succeeded in reaching the sac without causing any loss of blood. Tracheotomy has now been performed a number of times by the galvanic knife, no hemorrhage resulting. One method consists first in transfixing the tissues, including the trachea, and then heating the wire sufficiently to cut through. This, however, is not so neat and efficient an operation as cutting through with the galvanic knife. Can- cer of the mamma may also be removed as other external morbid growths by the same means. The special indica- tion for the galvanic knife is the existence of deep-seated disease where, if hemorrhage occurs, it may be difficult to arrest it. Uterine cancer, tubal pregnancy, and trache- otomy are operations especially adapted to this method. The Electric Osteotome. — Under the title of the " electric osteotome," Dr. Milton Josiah Roberts, of New York, describes" a new instrument for the performance o various operations on bone. It "consists of a small electro- motor, supplied with electricity, through insulated wires, from a powerful ten-cell primary zinc-carbon battery, and carrying a circular saw that revolves in a plane parallel with that of the central shaft. A hollow cylinder with a ^ The New York Medical Journal, June, 1875. ' The New York Medical Monthly, October, 1886. 278 ELECTRICITY IN SURGERY. collar-like base is firmly screwed to the end plate of the motor. Upon this a soft rubber hand-piece, fashioned like that of a carpenter's chisel, is slipped and fastened in position, forming the handle of the instrument and enabling the surgeon to control it when operating. The central shaft of the motor is continuous through the hollow cylinder. At its distal end a right-angled mitre-gearing connects it with the saw-bearing point. A metal shield guards the proximal aspect of the serrated blade. Shields are provided for each size of saw. Four sizes of circular saws, viz., 32 (1% inch), 41 (1% inch), 51 (2 inches), and •63 (2^ inches) millimetres in diameter were originally provided. " Upon the plate opposite the end of the motor to which the hand-piece is attached are two binding-posts, which receive the ends of the insulated wires connecting the in- strument with the battery. "When using the electro-osteotome it is suspended by a solid rubber cord, six or seven millimetres in diameter, from the cross-bar of an adjustable crane screwed to the ed*Te of the operating table. In this way all weight is removed from the hand of the surgeon, leaving the instru- ment as thoroughly at his command as if it were a delicate probe." Dr. Roberts has made many improvements in the instru- ment since the original was constructed. The motor is covered to prevent accident to the operator, and it is so constructed that various drills as well as saws can be at- tached without delay. He has also contrived an ingenious electric lamp attached to the instrument so as to throw the light directly on the part operated on by saw or drill. 'The battery by which the motor is actuated " contains twelve cells, that can be so connected that they can be brouo-ht into the circuit for drivinor the motor. Two of the cells, however, are connected independendy. and are MEDICAL ELECTRIC HEATING AND LIGHTING. 279 designed to be used for lighting purposes. By means of the switch, however, which is connected with the motor circuit, the two cells ordinarily used for the lamp circuit can be cut out of the lamp circuit and brought into play for driving the motor. The switch-board is provided with two levers, by means of which in case a single cell in the battery is at fault it can be readily picked out from the others." The Cautery. — Platinum wire, coiled about a cone of porcelain, constitutes the " dome cautery." These are of various sizes. Platinum wire folded on itself is a con- venient cautery for small objects. Heated to a dull red or white heat, the cautery rapidly destroys the tissues of the morbid growths, or the unhealthy surface. It is used for the destruction of small polypi, ncsvi (Paul Bruns,^ Nela- ton^), cancer, hemorrhoids, etc. It is also a neat, effective, and but slightly painful method of reducing the size of JiypcrtropJiicd tonsils. Prolapse of the rectum, fistula in ano, hemorrhage from a wounded surface, etc., are mala- dies to the relief of which the cautery is especially appli- cable. In prolapse of the rectum, a vertical V-shaped portion of the prolapsed tissue is clamped, cut off with scissors, and then the surface is cauterized by the galvanic cautery. The surface of the fistula is cauterized by the platinum wire, and is then ready to unite, which it usually does. Another operation consists in cutting through the fistula with the galvanic loop. The cautery raised to a dull red heat is an excellent means for arresting hemor- rhage — general oozing, when it is deep-seated. Besides the above-described applications of galvano- causty, Apostoli^ has lately proposed the same method for the treatment of metritis and endometritis. To this process ' Berliner klinische Wochenschrift, Nos. 27 and 28, 1872, and No. 32, 1873. 2 Comptes Rendus des Seances de I'Academie des Sciences. ^ R'-vue de Therapeutique, etc., Sept. 1886, p.' 462. 280 ELECTRICITY IN SURGERY. he has appHed the term " uterine chemical galvano-causty." The apparatus employed by him consists in a Leclanche battery of sufficient power to furnish 200 milliamperes ; a celluloid tube for the vagina ; an intrauterine stem of pla- tinum — the cautery ; and an absolute galvanometer to measure the strength of the current used. The intra- uterine stem rendered sterile by heat, is slowly and care- fully introduced into the cavity. The introduction of the stem must not give pain, and no violence, hence, must be used. The intrauterine stem is connected with the posi- tive pole in hemorrhagic conditions only ; the negative in all other states. Always beginning with the mildest cur- rent, especially in the case of impressionable subjects, the strength is slowly increased to 100 milliamperes, some- times to 200 milliamperes, and for five to ten minutes in duration. Several hours of repose are enjoined after the operations, and they are repeated every second day, for several months, or until the cure is effected. Dr. Newman,' whose achievements in the electrolysis of stricture, have been described, has recently brought forward a new method for the treatment of hypertrophy op the pros- tate, of villous graniUations of the bladder, idcerations of the urethra, etc. Although the number of cases thus treated has not been sufficient to establish the method on a sure basis, enough is known to justify some attention to it in this place. The following description, taken from Dr. Newman's paper, will give the reader a satisfactory con- ception of the method: " The instrument is in the shape of a catheter, of smooth, polished metal, with a short curve. At the end of its con- vexity is a fenestrum, in which is placed a platinum wire to be heated. This wire may be shaped differently, either ' Galvano-cautery in Diseases of the Prostate, Bladder, and Urethra. Pamphlet. From the Journal of the American Medical Association, August 28, 1886. MEDICAL ELECTRIC HEATING AND LIGHTING. 281 Straight, curved, or serpentine, in order to get more or less surface cautery. The other end of the instrument is straight and forms the handle ; from this end emerge two wires, the heat conductors, each of which is connected by binding screws to electrode wires, which respectively go to the positive and negative pole of the battery. The current- breaker is attached to one pole at the handle. ''Any good galvano-cautery battery may be used with the instrument, but it is necessary, as before stated, so to regu- late the battery that it yields the exact electrical potential to be used for the operation. I use a Dawson's battery," which works to my entire satisfaction. Experiments are necessary to establish the standard. The heat must be of a high red color, just short of white heat, the instant the current-breaker is touched ; this heat must be kept while the wire is in contact with the mucous lining. Less elec- tricity is required to heat a free wire in dry air than to heat a wire held against a moist surface. The strength of the fluid is adjusted according to these requirements ; the ele- ments are immersed in the fluid to a certain depth, the electrode wires are regulated with regard to their size, length, etc." The mode of using the instrument is thus described by Dr. Newman : "The instrument is- connected with the electrode wires, which are then attached to the battery. The fluid in the cells must be of the right standard, and all the machinery in perfect order. When all is ready, I invariably let the cells down and try the instrument with a short flash. No matter what assurance I have of the perfection of the appli- ances, this little experiment excludes any possible failure. The prostatic portion to which the cautery is to be applied must have been ascertained, and the distance from the ' The Dawson battery resembles the Byrne, already described. 282 ELECTRICITY IN SURGERY. meatus measured. This distance is then marked on the instrument by a small rubber band. The patient, according to his preference, may stand erect, be on an operating table, or in bed. The instrument is then introduced so that the fenestrum with its platinum wire is in contact with the part to be cauterized. The operator will know by touch when the instrument is in the right place, and the measure will corroborate the correctness of the situation. One hand holds the instrument and the other sets the battery in motion, and then touches the little spring to connect the interrupter : a flash follows, the finger disconnects the cur- rent. Jn one moment the operation is done." The Medical Electric Light. — If a large quantity of galvanism is made to pass between the terminals, separated by a short Interval in the air, or is made to traverse an in- ferior conductor, as platinum wire, the discharge is said to be by disruption and is attended with light and heat. This method is employed in electric lighting. When the termi- nals are of carbon, the molecules of the intervening stratum of air, but especially fine particles of carbon, are rendered incandescent, and the brilliant light is due to this. A me- chanical device is necessary to keep the terminal carbons at the proper interval, since a gradual erosion of the carbon point is going on. In Dubosq's lamp, and others of the same pattern (Fig. 94), a clock-work is so arranged as to effect this object. If the terminals are connected by platinum or a fine film of carbon, the large quantity of electricity passing is so con- densed as to heat the material conducting it to an intense degree, which renders it brilliantly luminous. Storage Cells._ — It has been ascertained that certain elements may be charged by another battery, so as to fur- nish a current of considerable quantity for several hours. The principle is that of polarization, and may be explained as follows : When two strips of platinum in water are made MEDICAL ELECTRIC HEATING AND LIGHTING. 288 the terminals of a battery, it is found that the strip con- nected with the anode is covered with minute bubbles of oxygen gas, and the other, connected with the cathode, is Fig. 94. Electric lamps. covered with bubbles of hydrogen gas. If now the strips are separated from the battery, and connected with a gal- vanometer, it is at once seen that a current of polarization is passing from the hydrogen to the oxygen through the liquid, which is opposite in direction to the battery current. 284 ELECTRICITY IN SURGERY. It has been further ascertained by Plante that this polariza- tion current may last a long time if the plates are large enough. Availing himself of these facts, Plante has con- structed '' secondary cells'' as they are entitled, which fur- nish a large volume of electricity, sufficient, indeed, to be used for the purpose of illumination and galvano-causty. As the principle here involved is of great importance, and as it is likely to enter largely into the construction of medi- cal electrical apparatus, the reader ought to have a clear comprehension of it and of the apparatus. The following is the arrangement of Plante's cell (Fig. 95) : "It consists Fig. 95 Plante's cell. of two plates of lead rolled into spirals, L, one within the other, but kept from contact by means of strips of vulcanite, /, y, /'. They are connected to the polarizing battery by means of two wires, E, F, and two terminals, C, D, which give the polarization current. To set the battery in action, we have simply to fill this secondary cell with water con- taining ten per cent, of sulphuric acid, and connect it by means of the binding screws at i^. 7% to a battery of four Daniell cells, or two Bunsens," continuing in action thus MEDICAL ELECTRIC HEATING AND LIGHTING. 285 for several hours, the secondary cell is found to be charged. To draw off the polarization current, it is only requisite to attach the necessary electrodes to C, D, when the current will flow until that stored up is disposed of Batteries are now constructed in accordance with this principle on a large scale. They are called "accumulators," storage cells," etc. In France, the accumulators of Faure are largely used, and have been introduced into this country. The electric energy stored up in these cells is given out when required. Their power is limited only by size. Charged in Paris, some of Fig. 96. I Trouve's polyscope. the Faure accumulators have been utilized on the voyage for lighting the ship, and others have since been employed in mechanical work. Obviously, the power thus obtained can be transported to any point, and used for any kind of mechanical work on this side. Availing himself of this principle, M. Trouve has con- trived the electrical polyscope. Constructed as above 286 ELECTRICITY IN SURGERY. described, it is contained in a quadrangular case about one foot in height, and six inches across. At the bottom are the wires + and — for attaching the battery which charges the polyscope, and at the top are the poles for attaching the electrodes or the handle (Fig. 96). There is also a rheostat, A, for regulating the resistance or Fig Larynx reHectors. strength of the currents, and a galvanometer, B. The handle is of a form usually employed for galvano-caustic operations, and has a sliding button, /^, for making and breaking the circuit. The handle is represented carry- ing a platinum knife, and has binding screws at V for MEDICAL ELECTRIC HEATING AND LIGHTING. 2S7 attaching either knives, cautery domes, or mirrors for illumination. Figs. 97, 98, 99, and 100 represent mirrors for illuminating the throat, larynx, mouth, etc., and there are also illuminators for the eye, ear, and internal cavi- ties.' The polarizing current stored up has sufficient volume for the operations in galvano-caustic surgery, and for the various kinds of illumination. The night before the polyscope is to be used, the charging battery is attached, and the current is allowed to flow. On the fol- lowing morning the polyscope will be found to contain a sufficient charge for the purpose of illumination or galvano- causty. The Electric Laryngoscope. — By this term is de- scribed a new reflecting laryngoscope mirror, invented by Dr. A. Wellington Adams,' of Colorado Springs. This is composed of a throat mirror E attached by a ball-and- socket joint F lo the shank A' and handle. Fixed to the handle by a shaft which permits complete rotation is a vertical support /, having a short horizontal arm C D, to which, by a ball-and-socket joint, is attached the illumi- nating apparatus. In a brass case B is contained "a glass carbonic acid tube bent in the form of a spiral, and having a platinum wire hermetically sealed within it. A, and at the back of the case and behind the vacuum tube is a plane concave mirror with a focal distance equal to the space between it and the position of the throat mirror upon which it is intended to reflect the rays of light emitted by the spiral vacuum tube." "Attached to one end of the handle is the shank, made of some light metal, and bent in such a way as to bring the' throat mirror attached to its free extremity upon a level with the spiral vacuum tube." The platinum wire of the vacuum tube ' Can be obtained from James W. Queen & Co., of this city, who have the apparatus in stock. ■ Archives of Laryngology, vol. i. No. iii. p. 268. 288 ELECTRICITY IN SURGERY. can be connected with the wires of a battery by means of the binding screws H H. The whole arrangement is shown in Fig-. loi. Dr. Adams advises that the electricity be furnished by a Ruhmkorff coil, worked by three Grenet cells. "For operating the instrument, however," he says, "I prefer an equivalent number of Leclanche cells, as this form of battery requires no special attention or renewal from one month to several years, according to use." When the con- nections are made with the batter)^ "a brilliant white light is emitted from the glass spiral," and "this light has neither heat nor gas, and is of such concentration and Fig. ioi. Adams's electric laryngoscope. intensity as to illuminate the respiratory tract down to a point nearly an inch below the bifurcation." The same principle may be applied to the otoscope, the ophthalmo- scope, and other instruments for illumination. Dr. Adams deserves the greatest credit for his skill and ingenuity ; but the means by which he proposes to produce the necessar}^ amount of electricity to render the platinum incandescent are by no means adequate. By the use of an accumulator, or by one of the batteries already de- scribed, the electric laryngoscope can be properly utilized. Several ingenious arrangements made by the S. S. White Company, of Philadelphia, are illustrated in the an- ME DICAL ELECTRIC HEATING AND LIGHTING. 289 Fig. I02. The electric laryngoscope of the S. S. White Company. 19 290 ELECTRICITY IN SURGERY. nexed figures. As will be seen, they are used for the otoscope, laryngoscope, etc. These are simpler in con- struction than the electric laryngoscope of Dr. Adams. Besides, they are relatively inexpensive, and are easily manipulated. Such means of illumination can be adapted to a variety of purposes. "The incandescent lamp A is mounted on a vulcanite base, B, set in a metal sleeve, C. A non-conductino- o-uard, D, with an aperture for the transmission of the light-rays, covers the lamp. The guard turns freely, enabling the operator to direct the light 'as he desires. The sleeve C is connected to the metal stem of the handle by means of a sliding ring, and the lamp may thus be moved up and down or revolved around the stem in any position. The lamp-wires pass through the lamp-base, one of them being wound around the stem a few turns, making it a part of the circuit; the other lamp-wire is connected with the gutta-percha-covered conductor which forms a spiral around the stem, passing through the handle to one of the term- inal posts. (The stem of the handle communicates with the second terminal.) The mirror is held by a sliding ring in clamping jaws formed by splitting the outer end of the handle extension. This method of organization permits the use of different sizes of mirrors. The handle proper is of hard wood, and is provided with a spring, G, which makes and breaks the circuit. In use the handle is held between the thumb and forefinger, the spring being pressed by the second finger to complete the circuit. The hard-rubber speculum is placed in a non-conducting frame carrying the lamp and the conductors, and a handle is provided so that after the otoscope is adjusted the pa- tient may hold it in position, leaving both of the operator's hands free for the use of instruments and the application of medicaments. The conducting cords are coupled to MEDICAL ELECTRIC HEATING AND LIGHTING. 291 the posts and the small end of the speculum inserted in the ear." The electric otoscope can also be used as an illuminator for the nares. W Electric otoscope of the S. S. White Company. The electric lantern will be found very useful to the surgeon when a strong light is desirable for the examina- tion of the throat. The light is supplied by an Edison five-candle lamp, run by the six-cell carbon cell battery. The most troublesome part of any electrical illuminator is the battery for actuating it. Any of these may be 292 ELECTRICITY IN SURGERY worked by the battery shown in Fig. 92, which consists of zinc-carbon cells contained in a box and having: a mechani- cal appliance — lever — for raising and lowering the ele- FiG. 104. Electric illuminator of the S. S. White Company. ments into the solution. Another (Fig. 104) illuminating apparatus consists of a cylinder provided with a concave mirror, in front- of which is placed the platinum coil for in- candescence. The author has a similar one in use and finds it works very well. PART VI. THERMO-ELECTRICITY. CHAPTER I. PRINCIPLES. When a current of electricity meets an obstruction in its course — as when a large volume of electricity is made to pass through a small platinum wire — heat is developed. Conversely, when the conduction of heat in the course of a conducting circuit is obstructed, electricity is developed. The conversion of heat into electricity takes place. The electrical current thus originated is known as thermo- electriciiy, and was first demonstrated by Seebeck so long ago as 1822. To demonstrate the phenomena a sensitive galvanom- eter is necessary (Fig. 105). If the wires of such a gal- vanometer are connected with a straight platinum wire, the latter may be heated at any point distant from its connections without producing the smallest movement in the needle of the galvanometer ; but " if the wire be made into a loop, its molecular tension at this point is slightly altered, and if heat be applied close to the loop and to the rig-ht of it. a current will flow througfh the apparatus from right to left, owing to the irregularity of the conducting power, and the disturbance in the regu- larity of the transmission of the force from the hotter to the colder portions. These effects are still more readily produced by dividing the wire into two portions, and coiling each extremity into a flat spiral. If one of these 294 THERM O-ELECTRICITV. spirals be heated to redness, and be brought into contact with the cold spiral, deflection of the needle of the gal- vanometer immediately follows, in a direction which indicates a flow of a current from the hotter to the colder portion."' Metals having an inferior conductivity Fig. 105. Egerton's universal j,Ai..j.wmelei' lor determining intensity or quantity. of electricity, in consequence of a crystalline structure, are especially suited to the demonstration of these phe- nomena. Thus, if bismuth and antimony are united together so as to form a ring — a closed circuit (Fig. 106), and one of the junctions is heated more than the other, a current of electricity is developed, the direction of which is the same for rings of these metals, but differs in different combinations and also by the degree of heat. The same phenomena are also exhibited in the case of a rectangular bar (Fig. 107), composed of two dissimilar metals, bismuth and antimony. The strength of the cur- ^ Miller's Chemical Physics, p. 481. PRINCIPLES. 295 rent, for a given temperature, is different with the different metals. To indicate variations and differences in tempe- rature, the thermo-electric combinations are more sensitive than any other yet devised. The following list is a thermo- electric scale originally devised by Becquerel. The metals are arranged in such an order that if any two constitute a Fig. ic6. Fig. 107. Ring of bismuth and antimony. Bars of bismuth and antimony. Deflection of the needle on heating a junction. couplet when joined, and are heated at the point of junc- tion, the current will pass from the higher on the list to the lower. Bismuth, Gold, Platinum, Silver, Lead, Zinc, Tin, Iron, Copper, Antimony. It follows that a combination of bismuth and antimony elements will furnish the strongest current. Further expe- rience has shown that certain alloys possess much greater electro-motive force. Thus Lombard' has shown that the best combination is an alloy of antimony for one bar, and bismuth alone for the other bar. A number of these ar- ranged in order, form a thermo-electric pile or battery (Fig. 108). When to the pile or battery a galvanometer is added, the whole constitutes a thermo-electric multiplier ' The Regional Temperature of the Head, by J. S. Lombard, M.D. Lond., H. K. Lewis, 1879, p. 19. 296 THERMO-ELECTRICITY. (Fig. 109). The shaded bars A are intended to represent the bars of antimony or an alloy of antimony, and those Fig. 108. Thermo-electric pile. The thermo-electric multiplier. given in outline, B, represent bismuth. The upper sur- face, marked hot, is heated, whilst the under surface, marked cold, is kept cool. The difference in temperature Fig. ho. Lombard's thermo-electric apparatus. MEDICAL USES OF THERMO-ELECTRIC PILE. 297 originates a current, which, starting from the antimony, passes to the bismuth, and thence to the galvanometer G. As perfected by Lombard, the thermo-electric multiplier becomes excessively sensitive to changes of temperature. When the outer face of the battery is applied to a warm surface, an immediate deflection of the needle occurs. The thermo-pile of Lombard consists of eight pairs oi bismuth and an alloy composed of 64.43 P^-rts of antimony and 35.57 of zinc. The pairs are fitted into ebonite caps eight-tenths of an inch in height, and the same in diameter. Two piles are necessary to make comparative observa- tions. As the size of the elements — the bars of bismuth and antimony — does not determine the effect, there is no ad- vantage' in having large elements, except as in so far the conduction is increased. The best arrangement of the pile for uses connected with medical practice, is that of Lombard. CHAPTER IL MEDICAL USES OF THE THERMO-ELECTRIC PILE. The mercurial thermometer indicates the intensity of heat, and may be employed in medical practice to deter- mine the heat of the body, and to ascertain the variations, if any exist, between the several parts. For the latter purposes the "surface thermometer" and the thermo- electric pile should be employed. The former, because of its size, facility of use, and comparatively low price, must continue to be used chiefly. For nice investigations, to detect minute differences in temperature, there is no ques- tion of the superiority of the latter. As it has been brought forward recently as a method of physiological 2H8 THERMO- F.LECTRICITY research, and has been utiUzed in medical diaenosis, it seems desirable in this work to devote some little attention to these several points. The natural variations in the temperature of the body- in different situations, at different hours of the day, and under the influence of various disturbing causes, have been investigated with more or less success since ther- mometry came into general use, but it was not until the thermo-multiplier was employed for this purpose that nice discriminations became possible. Acting on the sugges- tion of Lombard, and employing his thermo-electric appa- ratus, Hammond was the first to establish distinctly the fact, that the left side of the brain is, in the normal con- dition, higher in temperature than the right. It would be a distinct digression from the proper subject of this work to include the results obtained by observations with ther- mometers made by Broca, Dr. L. C. Gray, of Brooklyn, Prof. Schiff, Prof Paul Bert, Dr. Amidon, of New York, and others, and I, therefore, pass them over. "In 1866 Dr. Lombard commenced a series of experiments with thermo-electric apparatus, on the temperature of the human head in the quiescent mental condition, and in the states of intellectual and emotional activity. These experi- ments showed that the exercise of the hicfher intellectual faculties, as well as the different emotions, caused a rise of temperature in the head, perceptible through the medium of delicate apparatus. Merely arousing the attention could produce the same result."' Lombard has published a large number of observations which seem to prove his postulate. Although not strictly included in the sphere of this chapter, I may so far digress as to state that these results, obtained with so much care and faithful work, are, after all, vitiated by the fact that the temperature of the ^ Experimental Researches on the Regional Temperature of the Head, by J. S. Lombard, M.D. London, H. K. Lewis, 1879. i MEDICAL USES OF THERMO-ELECTRIC PILE. 299 scalp may vary greatly under circumstances of mere motor activity. Thus, Dr. Amidon, of New York, apparently proved that the action of groups of muscles caused a rise of temperature in the motor centres of the cerebral cortex, demonstrated, he maintained, by a special elevation of the heat of the scalp overlying the supposed region. Thus, working the arm violently for some minutes, it was ascer- tained that the temperature of the motor centre of the opposite hemisphere was raised above the ordinary level. It seems clear, however, that the surface of the body is liable to great fluctuations of temperature, and that the changes supposed to occur in the brain go no deeper than the scalp. When, however, inflammatory action occurs in the thoracic and abdominal organs, the walls of the cavity corresponding to the position of the inflamed organs may be warmer than the symmetrical region on the healthy side. A good many observations have been made on this point, and the fact of such rise of temperature seems conclusively established. To determine these variations under all circumstances is an important work for future investigators. Hence, it follows that the thermo-electric pile, the most sensitive of all means for determining minute variations in temperature, must come into more general use for the purposes above indicated. INDEX. ACNE, 227 Amaurosis, 222 Amblyopia, 222 Amenorrhoea, 242 Amidon on temperature, 298 Ampere, 40 Anaesthesia, 220, 223 Analgesia, 220 Aneurism, 254 Angina pectoris, 219 Animal currents, 96 electricity, 95 Anode, 47 Anosmia, 221 Antero-lateral sclerosis, 185 Aphonia, 200 Ascites, 228 Asthma, spasmodic, 170 Atonic dyspepsia, 233 Atrophy, progressive muscular, 1S3 Auditory nerve ansesthesia, 223 reactions, 124 BASEDOW'S disease, 226 Batteries, 46, 251 Batteries, galvano-caustic, 267 permanent, 57 portable, 60 single fluid, 47 Bladder, irritability of, 243 Blepharospasm, 168 Brain, action of currents on, 118 affections of, 159 ansemia of, 160 congestion of, 159 Brenner's polar method, 115 Brush dynamo-electric machine, 77 Burquism, 142 Byrne's battery, 269 CABINET battery, 61 Cancer, electrolysis of, 865 Cardiac depression, 236 Catalytic, 238 Catarrh, naso-pharyngeal, 232 of stomach, 234 Cathode, 47 Cells, arrangement of, 56 Cerebral ansemia, 160 congestion, 159 diseases, 158 Cervico-brachial neuralgia, 210 Chloride battery, 56 Chorea, 147, 167 Combination battery, 82 Commutator, 70 Conduction, 45 Conduction plate, 37 Conductors, 28 Conjunctive wire, 37 Constipation, 234 Convection, 46 Cramp, 166 Current direction, 40 intensity, 41 selector, 60 volume, 42 Cylinder machine, 34 Cystic tumors, electrolysis of, 262 Cysts, ovarian, 262 DANIELL'S battery, 51 Derived currents, 89, 123 Diagnosis by electricity, 125 Diamagnetic, 23 Diffusion, 89 Dip, 25 Diphtheritic paralysis, 204 Direct applications, 100 Disruption, 46 Double touch, 26 Du Bois-Reymond's battery. 73 theory, 95 Duchenne's battery, 75 Dufay's theory, 28 Dynamical electricity, 36 Dynamo, 77 Dyne, 18 Dyspepsia, 233 EAR, effects of galvanism on, 12 i Echinococci, electrolysis of, 262 Eczema, 227 302 INDEX. Electric baths, 84 dipolar, 85 monopolar, 85 Electric currents on the brain, 118, 158 ear, 123 eye, 123 heart, 122 pneumogastric nerve, 122 spinal cord, 120 laryngoscope, Adams's, 2S7 S. S. White Co.'s, 289 lighting, 282, 286 otoscope, 291 ray, 95 shad, 95 torpedo, 95 Elecirical illumination, 282, 292 cylinders, 31 induction, 30 machines, 30 Toepler-Holtz, 32 plate, 30 Electricity, resinous, 27 static, 26, 148 vitreous, 27 Electrization by sparks, 156 general, 92 Electro-capillarity, 99 Electro-contractility, 125 Electrodes, 91, 246, 249 Electro-diagnosis, 125 Electrolysis, 44, 249 in aneurism, 254 in cancer, 265 in cystic tumors, 262 in fibroid tumors, 265 in naevi, 263 in polypi, 263 in stricture, 263 in superfoetation, 264 Electrolyte, 249 Electro- magnetism, 64 Electro-negative, 47, 249 Electr(5-physiology, 95 Electro-posiiive, 47, 124 Electro-sensibility, 136 Electro-therapeutics, 141 Electrotonic state, 99, 106 Electrotonus, 99 Energy, 18 Enteralgia, 219 Epilepsy, 166, 202 Erg, 18 Exciting fluid, 89 Exophthalmic goitre, 224 Extrauterine pregnancy, 240 FACIAL paralysis, 187 Farad, 40 Faradic battery, 69 Faradic excitability, 115 Feigned diseases, 139 Fibroid tumors, electrolysis of, 265 Flemming l)attery, 57, 69, 70, 80 Formula;, 116 normal, 1 16 Franklinic electricity, 26, 154 Franklinization, general, 154 GAIFFE battery, 81 Galvani, 35 Galvanic couplet, 36 excitability, 114 Galvanism, 35 Galvano-caustic batteries, 268 cautery, 279 knife, 276 loop, 273 Galvano-Faradic Co.'s battery, 70 Galvano-faradization, 84 Galvanometers, 37, 294 Galvano-multiplier, 294 Gastralgia, 219 General electrization, 92 Generating plate, 37 Graves's disease, 224 Gravity battery, 54 Grenet cell, 47, 68 Grove's battery, 50 HALL'S battery, 81 Hammer, Neefs, 70 Heart, action of currents on, 122 depression of, 237 poisons of, 236 Hemiantesthesia, 203 Hemicrania, 217 Hemorrhage, 238 postpartum, 238 Hernia, strangulated, 135 Herpes zoster, 21 1 Hiccough, 169 Hill's gravity battery, 53 Histrionic spasm, 167 Holti machine, 153 Horseshoe magnet, 25 Hydrocele, 266 Hysterical aphonia, 200 paralysis, loi Hystero-epilepsy, 202 IMPACTION of intestine, 234 [ Impotence, 243 Indirect applications, 91 Induced contractions, 108 Induction, 30, 65 Infantile paralysis, 178 pseudo-hypertrophic, 179 INDEX. 308 Insulators, 28 Intensity, 40 Interrupter, 69 Intestines, impaction of, 234 Irritability, loi muscular, loi, III nerve, 106, 109 of bladder, 243 K IDDER battery, 79 LABILE applications, 90 Lead paralysis, 205 Leclanche element, 54 Leyden jars, ^^ battery of, ^^ Lighting, electrical, 282 Lode-stone, 21 Lombard's ihermo-muUiplier, 294 on temperature of head, 292 Lumbago, 213 MAGNETIC bodies, 23 field, 25 poles, 22 Magnet, 21, 25, 145 artificial, 21 natural, 21 Magnetism, 21 Magneto-electrical machines, 73 Magneto-electricity, 73 Magnetotherapy, 141 Mania, 163 Medical electricity, 18 Mental diseases, 163 Menorrhagia, 238 Microfarad, 42 Migraine, 217 Motor points, 206 Muscle current, 95 curve, 104 reactions, 129 Myalgia, 213, 230 Myelitis, 175 N^VI, electrolysis of, 263 Neef's hammer, 69 jS'erve currents, 98 reactions, 130 Neuralgia of the fifth nerve, 209, 219 cervico-bracial, 210 intercostal, 21 1 intestinal, 221 plumbic, 230 sciatic, 212 stomachal, 221 visceral, 217 Neuritis, 19S general multiple, i( multiple, 198 simple, 198 OBSTRUCTION of the bowels, 234 Ocular paralyses, 199 CEdema, 228 Ohm, 40 Ohm's law, 39, 57 Opium narcosis, 236 PARALYSIS, diphtheritic, 204 facial, 187 hysterical, 200 infantile, 179 ocular, 199 peripheric, 187 plumbic, 205 pseudo-hypertrophic, 179 rheumatic, 194 spinal, 173 Paraplegia, 173 syphilitic, 228 Partz battery, 49 Perkins's tractors, 141 Flate-glass machine, 32 Pneumogastric nerve, 121 Polarity, 22 Polar method, 1 15 formulae of, 1 16 Pole board, 59 Polypi, 258 Polyscope, 264 Portable battery, 57 Posterior spinal sclerosis, 185 Potential, 19, 34 difference of, 34 negative, 19 positive, 19 Progressive locomotor ataxia, 185 muscular atrophy, 183 Prurigo, 227 Psoriasis, 227 REACTIONS of degeneration, 134 Remak's battery, 62 Resinous electricity, 27 Resistance, 42 coils, 42, 60 external, 41 internal, 41 Respiration, depression of, 237 Retained placenta, 238 Retina, effect of galvanism on, 123 Isheosiat, 42 KliL'Otome, 70 304 INDEX, Rheumatism, acute, 214 chronic, 214, 219 muscular, 213 Ruhmkorff coil, 67 QCIATICA, 212 yj Scleroderma, 227 Sclerosis of the cord, 185 Siemen's unit, 61 Siemens and Halske cup, 52 Single touch, 26 fluid batteries, 46 Singultus, 169 Smee's element, 46 Spasm, electricity in, 166 Spasmodic asthma, 170 Special senses, action of electricity on, 123 Spinal cord, action of currents on,.i2 Stabile applications, 90 Static electricity, 148, 154 laws of, 27 therapy, 148, 156 Stohrer's battery, 48 Stomach, catarrh of, 233 dilatation of, 233 Storage cells, 282 Strangulated hernia, 235 Stricture of cesophagus, 169 urethra, 263 Syphilitic affections, 228 TEMPERATURE of the body, 298 Tetanus, 170 Thermo-electricity, 293 Thermo-electric multiplier, 294 pile, 295 its uses, 296 Tic douloureux, 209 Toepler-Holtz machine, 153 Torticollis, 168 Trophic neuroses, 224 Trouve's polyscope, 285 Tubal pregnancy, 240 Tumors, cystic, electrolysis of, 262 fibroid, electrolysis of, 265 URETHRA, stricture of, 263 Uterine disorders, 237 Uterine hemorrhage, 238 inertia, 2^8 VANSANT on magneto-therapeutics, 142 Vaso-motor neuroses, 224 Visceral neuralgia, 217 Vitreous electricity, 27 Volt, 39 Voltameter, 41 Vomiting, 233 WEBER, 41 Womb disorders, 238 Writer's cramp, 171 Wry neck, 168 LEA BROTHERS &> CO.'S (Late HENRY C. 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Table of eruptive fevers. Lists of new remedies and remedies not generally used, Incompatibles, Poisons and Antidotes. Artificial respiration. Table of doses, prepared to accord with the last revision of the U. S. Pharmacopoeia, an extended table of Diseases and their remedies, and directions for Ligation of Arteries. Blanks for all records of practice and Erasable tablet. Handsomely bound in limp Morocco, with tuck, pencil, rubber and catheter scale. In response to numerous requests, The Medical News Visiting List for 1887 is issued in three sizes, viz. : Dated, for 30 patients per week, 1 vol. ; dated, for 60 patients, 2 vols. ; dated, for 90 patients, 3 vols. ; Price per volume, $1.25. Also, furnished with Ready Reference Thumb-letter Index for quick use, 25 cents additional. For special offers, including Visiting List, see above. TSE MEDICAL NEWS PHYSICIANS' LEDGER, Containing 400 pages of fine linen " ledger " paper, ruled so that all the accounts of a large practice may be conveniently kept in it, either by single or double entry, for a long period. Strongly bound in leather, with cloth sides, and with a patent flexible back, which permits it to lie perfectly flat when opened at any place. Price, $5.00. Also, a small special lot of same Ledger, with 300 pages. Price, $4.00. HARTSHORNE, HENRY, A, M,, M, D,, LL. D,, Lately Professor of Hygiene in the University of Pennsylvania. A Conspectus of the Medical Sciences ; Containing Handbooks on Anatomy, Physiology, Chemistry, Materia Medica, Practice of Medicine, Surgery and Obstetrics. Second edition, thoroughly revised and greatly improved. In one large royal 12mo. volume of 1028 pages, with 477 illustrations. Cloth, $4.25 ; leather, $5.00. The object of this manual is to afford a conven- ient work of reference to students during the brief moments at their command while in attendance upon medical lectures. It is a favorable sign that it has been found necessary, in a short space of time, to issue a new and carefully revised edition. The illustrations are very numerous and unusu- ally clear, and each part seems to have received its due share of attention. We can conceive such a work to be useful, not only to students, but to practitioners as well. It reflects credit upon the industry and energy of its able editor. — Boston Medical and Surgical Journal, Sept. 3, 1874. We can say with the strictest truth that it is the best work of the kind with which we are ac- quainted. It embodies in a condensed form all recent contributions to practical medicine, and is therefore useful to every ousy practitioner through- out our country, besides being admirably adapted to the use of students of medicine. The hooK is faithfully and ably executed. — Charleston Medical Journal, April, 1875. NEILL, JOHN, M, D,, and SMITH, F, G,, 31, D., Late Surgeon to the Penna. Hospital. Prof, of the Listitutes of Med. in the Univ. of Penna. An Analytical Compendium of the Various Branches of Medical Science, for the use and examination of Students. A new edition, revised and improved. In one large royal 12mo. volume of 974 pages, with 374 woodcuts. Cloth, $4 ; leather, $4.75. LUDLOW, J,L,,M.D,, Consulting Physician to the Philadelphia Hospital, etc. A Manual of Examinations upon Anatomy, Physiology, Surgery, Practice of Medicine, Obstetrics, Materia Medica, Chemistry, Pharmacy and Therapeutics. To whicn is added a Medical Formulary. 3d edition, thoroughly revised, and greatly enlarged. In one 12mo. volume of 816 pages, with 370 illustrations. Cloth, $3.25 ; leather, $3.75. The arrangement of this volume in the form of question and answer renders it espe- cially suitable for the office examination of students, and for those preparing for graduation. 4 Lea Brothers & Co.'s Publications — Dictionaries. DTINGLISONf BOBLEY, M. !>., Late Professor of Institutes of Medicine in the Jefferson Medical College of Philadelphia. MEDICAL LEXICON; A Dictionary of Medical Science : Containing a concise Explanation of the various Subjects and Terms of Anatomy, Physiology, Pathol- ogy, Hygiene, Therapeutics, Pharmacology, Pharmacy, Surgery, Obstetrics, Medical Juris- prudence and Dentistry, Notices of Climate and of Mineral Waters, Formulas for Officinal, Empirical and Dietetic Preparations, with the Accentuation and Etymology of the Terms, and the French and other Synonymes, so as to constitute a French as well as an English Medical Lexicon. Edited by J iIchard J. Dunglison, M. D. In one very large and handsome royal octavo volume oJ 1139 pages. Cloth, |6.50; leather, raised bands, $7.50; very handsome half Russia, raised bands, $8. The object of the author, from the outset, has not been to make the work a mere lexi- con or dictionary of terms, but to afford under each word a condensed view of its various medical relations, and thus to render the work an epitome of the existing condition of medical science. Starting with this view, the immense demand which has existed for the work has enabled him, in repeated revisions, to augment its completeness and usefulness, until at length it has attained the position of a recognized and standard authority wherever the language is spoken. Special pains have been taken in the preparation of the present edition to maintain this enviable reputation. The additions to the vocabulary are more numerous than in any previous revision, and particular attention has been bestowed on the accentuation, which will be found marked on every word. The typographical arrangement has been greatly improved, rendering reference much more easy, and every care has been taken with the mechanical execution. The volume now contains the matter of at least four ordinary octavos. About tne first book purchased by the medical student is the Medical Dictionary. The lexicon explanatory of technical terms is simply a sine qua non. In a science so extensive and with such col- laterals as medicine, it is as much a necessity also to the practising physician. To meet the wants of students and most physicians the dictionary must be condensed while comprehensive, and practical while perspicacious. It was because Dunglison's met these mdications that it became at once the dictionary of general use wherever medicine was studied in the English language. In no former revision have the alterations and additions been 80 great. The chief terms have been set in black letter, while the derivatives follow in small caps; ftn arrangement which greatly facilitates reference. • — Cincinnati Lancet and Clinic, Jan. 10, 1874. A book of which every .'American ought to be proud. When the learned author of the work passed away, probably all of us feared lest the book should not maintain its place in the advancing science whose terms it defines. Fortunately, Dr. Richard J. Dunglison, having assisted his father in the revision of several editions of the work, and having been, therefore, trained in the methods and imbued with the spirit of the book, has been able to edit it as a work of the kind should be edited — to carry it on steadily, without jar or inter- ruption, alonp the grooves of thought it has trav- elled during its lifetime. To show the magnitude of the task which Dr. Dunglison has assumed and carried through, it is only necessary to state that more than six thousand new subjects have been added in the present edition. — Philadelphia Medical Times, Jan. 3, 1874. It has the rare merit that it certainly has no rival in the English language for accuracy and extent of references. — London medical Gazette. SOBLYW, BICMABn D., M. J>. A Dictionary of the Terms Used in Medicine and the Collateral Sciences. Revised, with numerous additions, by Isaac Hays, M. D., late editor of The American Journal of the Medical Sciences. In one large royal 12mo. volume of 520 double-columned pages. Cloth, $1.50 ; leather, $2.00. It is the best book of definitions we have, and ought always to be upon the student's table. — Southern Medical and Surgical Journal. STVDBNTS' SBBIBS OF MANTfALS. A Series of Fifteen Manuals, for the use of Students and Practitioners of Medicine and Surgery, written by eminent Teachers or Examiners, and issued in pocket-size 12mo. volumes of 300-540 pages, richly illustrated and at a low price. The following vol- umes are now ready: Treves' Manual of Surgery, by various writers, in three volumes, each, §2 ; Bell's Comparative Physiology and Anatomy, $2 ; Gould's Surgical Diagno- sis, $2 ; Robertson's Physiological Physics, $2 ; Bruce's Materia Medica and Therapew- tics, $1.50; Power's Human Physiology, $1.50; Clarke and Lockwood's Dissectors? Manual, $1.50 ; Ralfe's Clinical Chemistry, $1.50 ; Treves' Surgical Applied Anatomy, $2 ; Pepper's Surgical Pathology, $2 ; and Klein's Elements of Histology, $1.50. The following are in press : Bellamy's Operative Surgery, Pepper's Forensic Medicine, and CuRNOW's Medical Applied Anatomy. For separate notices see index on last page. SBBIBS OF CLINICAL MANUALS. In arranging for this Series it has been the design of the publishers to provide the profession with a collection of authoritative monographs on important clinical subjects m a cheap and portable form. The volumes will contain about 550 pages and will be freely illustrated by chromo-lithographs and woodcuts. The following volumes are now ready: Hutchinson on Syphilis, $2.25; Marsh on the Joints, $2; Owen on Surgical Diseases of Children, $2 ; Morris on Surgical Diseases of the Kidney, $2.25 ; Pick on Fractures and Dislocations, $2 ; Butlin on the Tongue, $3.50 ; Treves on Intestinal Obstruction, $2 ; and Savage on Insanity and Allied Neuroses, $2. The following are in active preparation: Carter & Frost's Ophthalmic Surgery, Bryant on the Breast, Broadbent on the Pulse, Lucas on Diseases of the Urethra, and Ball on the Rectum and Anu^. For separate notices see index on last page. Lea Brothers & Co.'s Publications — Anatomy. 5 GRAY, HENRY, F, R. S., Lecturer on Anatomy at St. Oet}rge's Hospital, London. Anatomy, Descriptive and Surgical. The Drawings by H. V. Cartek, M. D., and Dr. Westmacott. The dissections jointly by the Author and Dr. Carter. With an Introduction on General Anatomy and Development by T. Holmes, M. A., Surgeon lo St. George's Hospital. Edited by T. Pickerixg Pick, F. R. C. S., Surgeon to and Lecturer on Anatomy at St. George's Hospital, London, Examiner in Anatomy, Royal College of Surgeons of England. A new American from the eleventh enlarged and improved London edition, thoroughly revised and re-edited by "William W. Keen, M. D., Professor of Anatomy in the Pennsylvania Academy of the Fine Arts, etc. To which is added the second American from the latest English edition of Landmarks, Medical and Surgi- cal, by Luther Holden, F. R. C. S. In one imperial octavo volume of about 1100 pages, with about 650 large and elaborate engravings on wood. Price of edition in black (see below) : Cloth, -SG ; leather, S" ; half Russia, §7.50. The price of edition in colorB will be announced shortly. This work covers a more extended range of subjects than is customary in the ordinary text-books, giving not only the details necessary for the student, but also the application to those details to the practice of medicine and surgery. It thus forms both a guide for the learner and an admirable work of reference for the active practitioner. The engravings form a special feature in the work, many of them being the size of nature, nearly all original, and having the names of the various parts printed on the body of the cut, in place of figures of reference with descriptions at the foot. In this edition a new departure will be taken by the issue of the work with the arteries, veins and nerves distinguished by different colors. The engravings thus form a complete and splendid series, which will greatly assist the student in forming a clear idea of Anatomy, and will also serve to refresh the memory of those who may find in the exigencies of practice the necessity of recall- ing the details of the dissecting-room. Combining, as it does, a complete Atlas of Anatomy with a thorough treatise on systematic, descriptive and applied Anatomy, the work will be found of great service to all physicians who receive students in their offices, relieving both preceptor and pupil of much labor in laying the groundwork of a thorough medical education. For the convenience of those who cannot afford the slight increase in cost necessi- tated by the use of colors, the volume will be published also in black alone, and main- tained in this style at the price of former editions, notwithstanding the largely increased size of the work. Landmarks, Medical and Surgical, by the distinguished Anatomist, Mr. Luther Holden, has been appended to the present edition as it was to the previous one. This work gives in a clear, condensed and systematic way all the information by which the practitioner can determine from the external surface of the body the position of internal parts. Thus complete, the work, it is believed, will furnish all the assistance that can be rendered by type and illustration in anatomical study. Also for sale separate — HOLDEN, LUTHER, F. R. C, S., Surgeon to St. Bartholomew'' s and the Foundling Hospitals, London. Landmarks, Medical and Surgical. Second American from the latest revised English edition, with additions by W. W. Keen, M. D., Professor of Artistic Anatomy in the Pennsylvania Academy of the Fine Arts, formerly Lecturer on Anatomy in the Phila- delphia School of Anatomy. In one handsome 12mo. volume of 148 pages. Cloth, $1.00. This little book is all that can be desired within Its scope, and its contents will be found simply in valuable to the young surgeon or physician, since they bring before him such data as he requires at every examination of a patient. It is written in language so clear and concise that one ought cians and surgeons is much to be encouraged. It inevitably leads to a progressive education of both the eye and the touen, by which the recognition of disease or the localization of injuries is vastly as- sisted. One thoroughly familiar with the facts here taught is capable of a degree of accuracy and a almost to learn it by heart. It teaches diagnosis by ] confidence of certainty which is otherwise unat- external examination, ocular and palpable, of the ! tainable. We cordially recommend the Landmarks body, with such anatomical and physiological facts I to the attention of every physician who has not as directly bear on the subject. It is eminently I yet provided himself with a copy of this useful, the student's and young practitioner's book. — Phy- j practical guide to the correct placing of all the aicinn a7id Surgeon, Nov. I88I. | anatomical parts and organs. — Canada Medical and The study of these Landmarks by both physi- | Surgical Journal, Dec. 1881. TflLSON, ERAS 31 US, F. R. S. A System of Human Anatomy, General and Special. Edited by W. H. Gobrecht, M. D., Professor of General and Surgical Anatomy in the Medical College of Ohio. In one large and handsome octavo volume of 616 pages, with 397 illustrations. Cloth, $4.00 ; leather, $5.00. CLELAND, JOHN, M. H., F, R, S., Professor of A natoviy and Phi/siologi/ in Queen's College, Onlway. A Directory for the Dissection of the Human Body. In one 12mo. volume of 178 pages. Cloth, $1.25. 6 Lea Brothers & Co.'s Publications — Anatomy. ALLIEN, MAJEtmSON, M. D., Professor oj Physiology in the University of Pennsylvania. A System of Human Anatomy, Including Its Medical and Surgical Relations. _ For the use of Practitioners and Students of Medicine. With an Intro- ductory Section on Histology. By E. O. Shakespeake, M. D., Ophthalmologist to the Philadelphia Hospital. Comprising 813 double-columned quarto pages, with 380 illustrations on 109 full page lithographic plates, many of which are in colors, and 241 engravings in the text. In six Sections, each in a portfolio. Section I. Histology. Section II. Bones and Joints. Section III. Muscles and Fascia. Section IV. Arteries, Veins and Lymphatics. Section V. Nervous System. Section VI. Organs of Sense, of Digestion and Genito-Urinary Organs, Embryology, Development, Teratology, Superficial Anatomy, Post-Mortem Examinations, and General and Clinical Indexes. Price per Section, $3.50 ; also bound in one volume, cloth, |23.00 ; very handsome half Kussia, raised bands and open back, $25.00. For sale by subscription only. Apply to the Publishers. Extract from Introduction. It is the design of this book to present the facts of human anatomy in the manner best suited to the requirements of the student and the practitioner of medicine. The author believes that such a book is needed, inasmuch as no treatise, as far as he knows, contains, in addition to the text descriptive of the subject, a systematic presentation of such anatomical facts as can be applied to practice. A book which will be at once accurate in statement and concise in terms ; which will be an acceptable expression of the present state of the science of anatomy ; which will exclude nothing that can be made applicable to the medical art, and which will thus embrace all of surgical importance, while omitting nothing of value to clinical medicine, — would appear to have an excuse for existence in a country where most surgeons are general practitioners, and where there are few general practitioners who have no interest in surgery. It is to be considered a study of applied anatomy in its widest sense — a systematic presentation of Buch anatomical facts as can be applied to the practice of medicine as well as of surgeiy. Our author is concise, accurate and practical in his statements, and succeeds admirably in infusing an interest into the study of what is generally con- sidered a dry subject. The department of Histol- ogy is treated in a masterly manner, and the ground is travelled over by one thoroughly famil- iar with it. The illustrations are made witn great care, and fire simply superb. There is as much of practical application of anatomical points to the every-day wants of the medical clinician as to those of tne operating surgeon. In fact, few general practitioners will read the work without a feeling of surprised gratification that so many Doints, concerning which they may never have thought before are so well presented for their con- sideration. It is a work which is destmed to be the best of its kind in any language. — Medionl Record, Nov. 25, 1882. CLARKE, W. J5., F.B. CS. <& LO CKWOOD, C. B., F.M. C. S, Demonstrators of Anatomy at St. Bartholomew's Hospital Medical School, London. The Dissector's Manual. In one pocket-size 12mo. volume of 396 pages, with Limp cloth, red edges, $1.50. See Students' Series of Manuals, page 4. IMessrs.ClarkeandLockwoodhave written a book I intimate association with students could have that can hardly be rivalled as a practical aid to the given. With such a guide as this, accompanied dissector. Their purpose, which is "how to de- j by so attractive a commentary as Treves' .S'Mr^icaZ 49 illustrations. scribe the best way to display the anatomical structure," has been fully attained. They excel in a lucidity of demonstration and graphic terseness of expression, which only a long training and Applied Anatomy (same series), no student could fail to be deeply and absorbingly interested in the study of anatomy. — New Chicans Medical and Sur- gical Journal, April, 1884. TREVES, FJREnEBICK, E. M. C. S., Senior Demonstrator of Anatomy and Assistant Surgeon at the London HospitaL Surgical Applied Anatomy. In one pocket-size 12mo. volume of 540 pages, with 61 illustrations. Limp cloth, red edges, $2.00. See Student^ Series of Manuals, page 4. He has produced a work which will command a larger circle of readers than the class for which it was written. This union of a thorough, practical acquaintance with these fundamental branches, quickened by daily use as a teacher and practi- tioner, has enabled our author to prepare a work which it would be a most difficult task to excel. — The American Practitioner, Feb. 1884. Preparing. CUMJSOW, JOMW, M, n., E. JR. C. E., Professor of Anatomy at King's College, Physician at King's College Hospital. Medical Applied Anatomy. In one pocket-size 12mo. volume. See Students' Series of Manuals, page 4. BELLAMY, EDWABn, E, B. C. S., Senior Assistant-Surgeon to the Charing-Cross Hospital, London. The Student's Guide to Surgical Anatomy : Being a Description of the most Important Surgical Kegions of the Human Body, and intended as an Introduction to operative Surgery. In one 12mo. volume of 300 pages, with 50 illustrations. Cloth, $2.25. HARTSHORNE'S HANDBOOK OF ANATOMY AND physiology. Second edition, revised. In one royal 12mo. volume of 310 pages, with 220 woodcuts. Cloth, 81.75. HORNER'S SPECIAL ANATOMY AND HISTOL- OGY. Eighth edition, extensively revised and modified. In two octavo volumes of 1007 pages, with 320 woodcuts. Cloth, $6.00. Lea Brothers & Co.'s Publications — Physics, Pliysiol.,Anat, dhafeb, jojbln a, m, j>., ll. n., Professor of Chemistry in the University of the City of New York. Medical Physics. A -Text-book for Students and Practitioners of Medicine. In one octavo volume of 734 pages, with 376 woodcuts, mostly original. Cloth, $-1. FROM THE PREFACE. The fact that a knowledge of Physics is indispensable to a thorough understanding of Medicine has not been as fully realized in this country as in Europe, where the admirable works of Desplats and Gariel, of Kobertson and of numerous German writers constitute a branch of educational literature to which we can show no parallel. A full appreciation of this the author trusts will be sufficient justification for placing in book form the sub- stance of his lectures on this department of science, delivered during many years at the University of the City of New York. Broadly speaking, this work aims to impart a knowledge of the relations existing between Physics and Medicine in their latest state of development, and to embody in the pursuit of this object whatever experience the author has gained during a long period of teaching this special branch of applied science. This elegant and useful work bears ample testi- mony to the learning and good judgment of the author. He has fitted his work admirably to the exigencies of the situation by presenting the reader with brief, clear and simple statements of such propositions as he is by necessity required to master. The subject matter is well arranged, liberally illustrated and carefully indexed. That it will take rank at once among the text-books is certain, and it is to be hoped that it will find a place upon the shelf of the practical physician, where, as a book of reference, it will be found useful and agreeablo. — Louisville Medical News, September 26, 1885. Certainly we have no text-book as full as the ex- cellent one he has prepared. It begins with a statement of the properties of matter and energy. After these the special departments of physics are explained, acoustics, optics, heat, electricity and magnetism, closing with a section on electro- biology. The applications of all these to physiology and medicine are kept constantly in view. The text is amply illustrated and the many difficult points of the subject are brought forward with re- markable clearness and ability. — Medical and Surg- ical Reporter, July 18, 1885. That this work will greatly facilitate the study of medical physics is apparent upon even a mere cursory examination. It is marked by that scien- tific accuracy which always characterizes Dr. Draper's,writings. Its peculiar value lies in the fact that it is written from the standpoint of the medical man. Hence much is omitted that ap- pears in a mere treatise on physical science, while much is inserted of peculiar value to the physi- cian.— .1/cfKcai Record, August 22, 1885. MOBEMTSOW, J. McGBEGOB, M. A,, M, B., Mtdrhead Demonstrator of Physiology, University of Olasgoxo. Physiological Physics. In one 12mo. volume of 537 pages, with 219 illustra- tions. Limp cloth, $2.00. See Students' Series of Manuals, page 4. The title of this work sufficiently explains the nature of its contents. It is designed as a man- ual for the student of medicine, an auxiliary to his text-book in physiology, and it would be particu- larly useful as a guide to his laboratory experi- ments. It will be found of great value to the practitioner. It is a carefully prepared book of reference, concise and accurate, and as such we heartily recommend it. — Journal of the American Medicdl Association, Dec. 6, 1884. jD ALTON, JOHN C, M. D., Professor Emeritus of Physiology in the College of Physicians and Surgeons, New York. Doctrines of the Circulation of the Blood. A History of Physiological Opinion and Discovery in regard to the Circulation of the Blood. In one handsome 12mo. volume of 293 pages. Cloth, $2. Dr. Dalton's work is the fruit of the deep research of a cultured mind, and to the busy practitioner it cannot fail to be a source of instruction. It will inspire him with a feeling of gratitute and admir- ation for those plodding workers of olden times, who laid the foundation of the magnificent temple of medical science as it now stands. — New Orleans Medical and Surgical Journal, Aug. 1885. In the progress of physiological study no fact was of greater moment, none more completely revolutionized the theories of teachers, than the discovery of the circulation of the blood. This explains the extraordinary interest it has to, all medical historians. The volume before us is one of three or four which have been written within a few years by American physicians. It is in several respects the most complete. The volume, though small in size, is one of the most creditable con- tributions from an American pen to medical history that has appeared.— il/ed. & Surg. Rep., Dec. 6, 1884. BJELL, F, JBFFBEY, M, A,, Professor of Comparative Anatomy at King's College, London. Comparative Physiology and Anatomy. In one 12mo. volume of 561 pages, with 229 illustrations. Limp clothj $2.00. See Students' Series of Manuals, page 4. The manual is preeminently a student's book — clear and simple in language and arrangement. It is well and abundantly illustrated, and is read- able and interesting. On the whole we consider it the best work in existence in the English language to place in the hands of the medical student. — Bristol Medico-Chirurgical Journal, Mar., 1886. JEBLIS, GEOBGB VINEB, Emeritus Professor of Anatomy in University College, London. Demonstrations of Anatomy. Being a Guide to the Knowledge of the Human Body by Dissection. From the eighth and revised London edition. In one very handsome octavo volume of 716 pages, with 249 illustrations. Cloth, $4.25 ; leather, $5.25. BOBEBTS, JOHN B., A, M., M, D., Prof, of Applied Anat. and Oper. Surg, in Phila. Polyclinic and Coll. for Oraduates in Medicine. The Compend of Anatomy. For use in the dissecting-room and in preparing for examinations. In one 16mo. volume of 196 pages. Limp cloth, 75 cents. 8 Lea Brothers & Co.'s Publications — Physiology, Chemistry. CHAPMAN, HENRY C, M. D., Professor of Institutes of Medicine and Medical Jurisprudence in the Jefferson Medical College of Philadelphia. A Treatise on Human Physiology. In one handsome octavo volume of about 1000 pages, profusely illustrated. Shortly. D ALTON, JOHN C, 31. J)., Professor of Physiology in the College of Physicians and Surgeons, New York, etc. A Treatise on Human Physiology. Designed for the use of Students and Practitioners of Medicine. Seventh edition, thoroughly revised and rewritten. In one very handsome octavo volume of 722 pages, with 252 beautiful engravings on wood. Cloth, $5.00 ; leather, $6.00 ; very handsome half Russia, raised bands, $6.50. This edition of Dr. Dalton's well-known work bears evi-ieace of having been thoroughly and careiuily revised. From the first appearance of the book it has been a favorite, owing as well to the author's renown as an oral teacher as to the charm of simplicity with which, as a writer, he always succeeds in investing even intricate sub- jects It must be gratifying to him to observe the frequency with which his work, written for students and practitioners, is quoted by other writers on physiology. This fact attests its value, and, in great measure, its originality. It now needs no such seal of approbation, however, for the thou- sands who have studied it in its various editions have never been in any doubt as to its sterling worth. — N. Y. Medical Journal and Obstetrical Re- view, Oct 1882. Professor Dalton's well-known and deservedly- appreciated work has long passed the stage at which it could be reviewed in the ordinary sense. The work is eminently one for the medical prac- titioner, since it treats mostfully of those branches of physiology which have a direct bearing on the diagnosis and treatment of disease. The work is one which we can highly recommend to all our readers. — Dublin Journal of Medical Science, Feb.'83. Certainly no physiological work as ever issued from the press that presented its subject-matter in a clearer and more attractive light. Almost every page bears evidence of the exhaustive revision that has taken nlace. The material is placed in a more compact form, yet its delightful cnarm is re- tained, and no subject is thrown into obscurity. Altogether this edition is far in advance of any previous one, and will tend to keep the profession posted as to the most recent additions to our physiological knowledge. — Michigan Medical News, April, 1882. FOSTER, MICHAEL, M. JX, F. B. S., Prelector in Physiology and Felloic of Trinity College, Cambridge, England. Text-Book of Physiology. Third American from the fourth English edition, with notes and additions by E. T. Reichert, M. D., Professor of Physiology in the Uni- versity of Pennsylvania. In one handsome royal 12mo. volume of 908 pages, with 271 illustrations. Cloth, $3.25 ; leather, $3.75. Dr. Foster's work upon physiology is so well- known as a text-book in this country, that it needs but little to he said in regard to it. There is scarcely a medical college in the United States where it is not in the hands of the students. The author, more than any other writer with whom we are acquainted, seems to understand what portions of the science are essential for students to know and what may be passed over by them as not important. From the beginning to the end, physiology is taught in a sj'stematic manner. To this third American edition numerous additions, corrections and alterations have been made, so that in its present form the usefulness of the book will be found to be much increased. — Cincinnati Medical Nacs, July 1885. FOWEB, HENRY, 31. B., F. B. C. S., Examiner in Physiology, Royal College of Surgeons of England. Human Physiology. In one handsome pocket-size 12mo. volume of 396 pages, with 47 illustrations. Cloth, $1.50. See Students' Series of Manuals, page 4. The prominent character of this work is that of judicious condensation, in which an able and suc- cessful effort appears to have been made by its accomplished author to teach the greatest number of facts in the fewest possible words. The result is a specimen of concentrated intellectual pabu- lum seldom suri)assed, which ought to be care- fully ingested and digested by every. practitioner who desires to keep himself well informed upon this most progressive of the medical sciences. The volume is one which we cordially recommend to every one of our readers. — The American Jour- nal of the Medical Sciences, October, 1884. This little work is deserving of the highest praise, and we can hardly conceive how the main facts of this science could have been more clearly or concisely stated. The price of the work is such as to place it within the reach of all, while the ex- cellence of its text will certainly secure for it most favorable commendation — Cincinnati Lancet and Clinic, Feb. 16, 1884. SIMON, W., Fh. D., 31. H., Professor of Chemistry and Toxicology in the College of Physicians and Surgeons, Baltimore, and Professor of Chemistry m the Maryland College of Pharmacy. Manual of Chemistry. A Guide to Lectures and Laboratory work for Beginners in Chemistry. A Text-book, specially adapted for Students of Pharmacy and Medicine. In one 8vo. vol. of 410 pp., with 16 woodcuts and 7 plates, mostly of actual deposits, with colors illustrating 56 of the most important chemical reactions. Cl«th, $3.00; also without plates, cloth, $2.50. This book supplies a want long felt by students | plates, beautifully executed, illustrating precipi- of medicine and pharmacy, and is a concise but i tates of various reactions, form a novel and valu- thorough treatise on the suoject. The long expe- | able feature of the book, and cannot fail to be ap- rience of the author as a teacher in schools of | predated by both student and teacher as a help medicine and pharmacy Is conspicuous in the | over the hard places of the science. — Maryland perfect adaptation of the work to the special needs Medical Journal, Nov. 22, 1884. of the student of these branches. The colored 1 "Wohler's Outlines of Organic Chemistry. Edited by Fittig. Translated by Ira Remsen, M. D., Ph. D. In one 12mo. volume of 550 pages. Cloth, $3. LEHMANN'S MANUAL OF CHEMICAL PHYS- IOLOGY. In one octavo volume of 327 pages, with 41 illustrations. Cloth, $2.25. CARPENTER'S HUMAN PHYSIOLOGY. Edited by Henrt Powek. In one octavo Tolume. CARPENTER'S PRIZE ESSAY ON THE USE AND Abuse of Alcoholic Liqcohs in Health and Dis- EA8E. Withexplanationsof scientific words. Smal> 12mo. 178 pages. Cloth, 60 cents. GALLOWAY'S QUALITATIVE ANALYSIS. Lea Brothers & Co.'s Publications — Chemistry. FBANKLANIf, B., D. O. i., F. B.S,, i&JAPP, F, R,, F, J. C, Professor of Chemistry in the Normal School of Science, London. Assist. Prof, of Chemistry in the Normal School of Science, London. Inorganic Chemistry. In one handsome octavo volume of 677 pages with 51 woodcuts and 2 plates. Cloth, $3.75 ; leather, $4.75. This work should supersede other works of its I This excellent treatise will not fail to take its class in the medical colleges. It is certainly better \ place as one of the very best on the subject of adapted than any work upon chemistry.with which ; which it treats. We have been much pleased we are acquainted, to impart that clear and full j with the comprehensive and lucid manner in knowledge of the science which students of med- ! which the difficulties of chemiijal notation and icine should have. Physicians who feel that their | nomenclature have been cleared up by the writers, chemical knowledge is behind the times, would do well to devote some of their leisure time to the study of this work. The descriptions and demon- strations are made so plain that there is no diffi- culty in understanding them. — Cincinnati Medical News, January, 18SG. It shows on every page that the problem of rendering the obscurities of this science ea-sy of comprehension has long and successfully engaged the attention of the authors. — Medical and Surgical Reporter, October 31, 1885. FOWNES, GEOBGB, Fh. 7>. A Manual of Elementary Chemisti'y; Theoretical and Practical. Em- bodying Watts' Physical Inorcjanic Chemistry. New American edition. In one large royal 12mo. volume of 1061 pages, with J.68 illustrations on wood and a colored plate. Cloth, $2.75 ; leather, $3.25. chemistry extant. — Cincinnati Medical News, Oc- tober, 1885. Of all the works on chemistry intended for the use of medical students, Fownes' Chemistry is perhaps the most widely used. Its popularity is based upon its excellence. This last edition con- tains all of the material found in the previous, and it is also enriched by the addition of Watts* Physical and Inorganic Chemistry. All of the mat- ter is brought to the present standpoint of chemi- cal knowledge. We may safely predict for this work a continuance of the fame and favor it enjoys among medical students. — New Orleans Medical and Surgical Journal, March, 188G. Foxones'' Chemistry has been a standard text- book upon chemistry for many years. Its merits are very fully known by chemists and physicians everywhere in this country and in England. As the science has advanced by the making of new discoveries, the work has been revised so as to keep it abreast of the times. It has steaiily maintained its position as a text book with medi- cal students. In this work are treated fully: Heat, Light and Electricity, including Magnetism. The Influence exerted by these forces in chemical action upon health and disease, etc., is of the most important kind, and should be familiar to every medical practitioner. We can commend the work as one of the very best text-booka upon ATTFIELD, JOHN, F7i. J>., Professor of Practical Chemistry to the Pharmaceutical Society of Great Britain, etc. Chemistry, General, Medical and Pharmaceutical; Including the Chem- istry of the U. S. Pharmacopoeia. A Manual of the General Principles of the Science, and their Application to Medicine and Pharmacy. A new American, from the tenth English edition, specially revised by the Author. In one handsome royal 12mo. volume of 728 pages, with 87 illustrations. Cloth, $2.50 ; leather, $3.00. to put himself in the student's place and to appre- ciate his state of mind. — American Chemical Jour- nal, April, 1884. A text-book which passes through ten editions in sixteen years must have good qualities. This remark is certainly applicable to Attfield's Chem- istry, a book which is so well known that it is hardly necessary to do more than note the appear- ance of this new and improved edition. It seems, It is a book on which too much praise cannot be bestowed. As a text-book for medical schools It is unsurpassable in the present .state of chemical however, desirable to point out that feature of the I science, and having been prepared with a special book which, in all probability, has made it so | view towards medicine and pharmacy, it is alike popular. There can be little doubt that it is its \ indispensable to all persons engaged in those de- ihoroughly practical character, the expression | partments of science. It includes the whole being used in its best sense. The author under- chemistry of the lastPharmacopceia. — Pacific Medi- fltanas what the student ought to learn, and is able 1 cal and Surgical Journal, Jan. 1884. BLOXAM, CHABLFS X., Professor of Chemistry in King's College, Londcm. Chemistry, Inorganic and Organic. New American from the fifth Lon- don edition, thoroughly revised and much improved. In one very handsome octavo volume of 727 pages, with 292 illustrations. Cloth, $3.75 ; leather, $4.75. the best manuals of general chemistry tn the Eng- lish language. — Detroit Lancet, Feb. 1884. Professor Bloxam's book is a very satisfactory one. We know of no treatise on chemistry which contains so much practical information in the same number of pages. The book can be readily adapted not only to the needs of those who desire a tolerably complete course of chemistry, but also to the needs of those who desire only a general knowledge of the subject. We fake pleasure in recommending this work both as a satisfactory text book, and sa useful book of reference.— £os- ., Fh, J>., Professor of Cheviistry in" the\Johnsl Hopkins University, Baltimore. Principles of Theoretical Chemistry, with special reference to the Constitu- tion of Chemical Compounds. New (third) and revised edition. In one handsome royal 12mo. volume of about 250 pages. In press. 10 Lea Brothers & Co.'s Publications — Chemistry. CHARLES^ T. CBANSTOVN, M, J)., F. C, S., M, S., Formerly Asst. Prof, and Deiaonst. of Chemistry and Chemical Physics, Queen^s College, Belfast. The Elements of Physiological and Pathological Chemistry. A Handbook for Medical Students and Practitioners. Containing a general account of Nutrition, Foods and Digestion, and the Chemistry of the Tissues, Organs, Secretions and Excretions of the Body in Health and in Disease. Together with the methods for pre- paring or separating their chief constituents, as also for their examination in detail, and an outline syllabus of a practical course of instruction for students. In one handsome octavo volume of 463 pages, with 38 woodcuts and 1 colored plate. Cloth, |3.50. This i.«, vre believe, the first complete work of the kind in the English language, and may well serve to show what progress is being made in medi- cine. The studelit will find condensed in one vol- ume such a store of knowledge as would formerly have cost him much reading to gather. The book will fully repay anyone to read, and every library should have it for reference.— iV'^eio Orleans Medical and Surgical Journal, April, 188.5. Dr. Charles is fully impressed With tlje import- ance and practical reach of his subject, and he ! has treated it in a competent and instructive man- ner. We cannot recommend a better book than I the present. In fact, it fills a gap in medical text- books, and that is a thing which can rarely be said I nowadays. Dr. Charles has devoted much space to the elucidation of urinary mysteries. He does this with much detail, and yet" in a practical and intelligible manner. In fact, the author has filled his book with many practical hinti-.— Medical Rec- ord, December 20, 1884. HOFFMAJVJS^, F., A.M., Fh,D,^ & FOWFM F.B., Fh.D., Public Analyst to the State of Neic York. Prof, of Anal. Chem.in the Phil. Coll. of Pharmacy. A Manual of Chemical Analysis, as applied to the Examination of Medicinal Chemicals and their Preparations. Being a Guide for the Determination of their Identity and Quality, and for the Detection of Impurities and Adulterations. For the use of Pharmacists, Physicians, Druggists and Manufacturing Chemists, and Pharmaceutical and Medical Students. Third edition, entirely rewritten and much enlarged. In one very handsome octavo volume of 621 pages, witli 179 illustrations. Cloth, $4.25. We congratulate the author on the appearance ; tion of them singularly explicit. Moreover, it is of the third edition of this work, published for the first time in this country also. It is admirable and the information it undertakes to supply is both extensive and trustworthy. The selection of pro- cesses for determining the purity of the substan- ces of which it treats Is excellent and the descrip- | exceptionally free from typographical errors. We have no hesitation in recommending it to those who are engaged either in the manufacture or the testing of medicinal chemicals. — London Pharrnct- ceutical Journal and Transactions, 1883. CLOWES, FMAJ^K, D. Sc, London, Senior Science-Master at the High School, Newca^tle-under-Lyme, etc. An Elementary Treatise on Practical Chemistry and Qualitative Inorganic Analysis. Specially adapted for use in the Laboratories of Schools and Colleges and by Beginners. Third American from tlie fourth and revised English edition. In one very handsome royal 12mo. volume of 387 pages, with 55 illustrations. Cloth, $2.50. We may simply repeat the favorable opinion for chemical work, he gradually unfolds the sub- which weexpressed after the examination of the Ject from its simpler to its more complex divisions, previous edition of this work. It is practical in its It is the most readable book of the kind we have aims, and accurate and concise in its statements, yet seen, and is without doubt a systematic, — American Journal of Pharmacy, Auf^nst,lSS5. intelligible and fully equipped laboratory guide The style is clear, the language terse and vigor- and text-book. — Medical Record, July 18, 1885. ous. Beginning with a list of apparatus necessary MALFF, CSABLFS S., M. D., F. B, C. F., Assistant Physician at the London Hospital. Clinical Chemistry. In one pocket-size 12mo. volume of 314 pages, with 16 illustrations. Limp cloth, red edges, $1.50. This is one of the most instructive little works that we have met with in a long time. The author is a physician and physiologist, as well as a chem- ist, consequently tne book is unqiialifiedly prac- tical, telling the physician just wnat he ought to know, of the applications of chemistry in medi- See Students' Series of Manuals, page 4. cine. Dr. Ralfe is thoroughly acquainted with the latest contributions to his science, and it is quite refreshing to find the suVjject dealt with so clearly and simplj', yet in such evident harmony with the modern scientific methods and spirit. — Medical Record, February 2, 1884. CLASSEN, ALEXANI>FB, Professor in the Royal Polytechnic School, Aix-la-Chapelle. Elementary Quantitative Analysis. Translated, with notes and additions, by Edgar F. »Smith. Ph. D., Assistant Professor of Chemistry in the Towne Scientific School, University of Peuna. In one 12mo. volume of 324 pages, with 36 illust. Cloth, $2.00. It is probably the best manual of an elementary nature extant, insomuch as its methods are the best. It teaches by examples, commencing with single determinations, followed by separations, and then advancing to the analysis of minerals and such products as are met with in applied chemis- try. It is an indispensable book for students in chemistry. — Boston Journal of Chemistry, Oct. 1878. GBEENE, WILLIAM H., 31. !>., Demonstrator of Chemistry in the Medical Department of the University of Pennsylvania. A Manual of Medical Chemistry. For the use of Students. Based upon Bow- man's Medical Chemistiy. In one 12mo. volume of 310 pages, with 74 illus. Cloth, $1.75. It is a concise manual of three hundred pages, I the recognition of compounds due to pathological giving an excellent summary of the best methods { conditions. The detection of poisons is treated of analyzing the liquids and solids of the body, both ; with sufficient fulness for the purpose of thestu- for the estimation of their normal constituents and i dent or practitioner.— Boston Jl. of Chein. June.'SO. Lea Brothers & Co.'s Publications — Pharm., Mat. Mecl., Therap. 11 BJRVNTOW, T. LAUnERf M.D., I>,Sc,, F.B.S., F,R,C,B,, Lecturer on Materia Medica and Therapeutics at St. Bartholomew's Hospital, London, etc. A Text-book of Pharmacology, Therapeutics and Materia Medica ; Including the Pharmacy, the Physiological Action and the Therapeutical Uses of Drugs. In one handsome octavo volume of 1033 pages, with 188 illustrations. Cloth, $5.50 ; leather, $6.50. It is a scientific treatise worthy to be ranked with 1 upon the subject of Pharmacology the compre- the highest productions in physiology, either in hensive work of Brunton is clearly the most our own or any other language. Everything is important, and is beyond question the foremost practical, the dry, hard facts of physiology being English handbook of Materia Medica and Thera- pressed into service and applied to the treatment peutics since the appearance of Pereira's Elements of the commonest complaints. The information of Materia Jledica in 1842. It is original both in is so systematically arranged that it is available the arrangement of the subjects and in the mode for immediate use. The index is so carefully of treatment, and develops in a comprehensive compiled that a reference to any special point is manner the foundation principles of the science at once obtainable. Dr. Brunton is never satisfied of Pharmacology without leaving the needs of the with vague generalities, but gives clear and pre- practitioner out of sight for an instant. In fact, else directions for prescribing the various drugs the author has written a book which deserves to anri, preparations. We congratulate students on ' be known far beyond the boundaries of England, being at last placed in possession of a scientific treatise of enormous practical importance. — The London Lancet, June 27, 1885. Of all the numerous publications of this year and can serve as a model for the pharmacological works of the continent on account of its happy combination of theory with practice. — Virchow's Jahresbericht, Berlin, 1886. BARTHOLOW, ROBERTS, A, M., M. J>., LL. £>., Professor of Materia Medica and General Therapeutics in the Jefferson Medical College of Phila- delphia. New Remedies of Indigenous Source: Their Physiological Actions and Therapeutical Uses. In one octavo volume of about 300 pages. Preparimj. PARRISS, EDWARD, Late Professor of the Theory and Practice of Pharmacy in the Philadelphia College of Pharviacy. A Treatise on Pharmacy : designed as a Text-book for the Student, and as a Guide for the Physician and Pharmaceutist. With many Formulae and Prescriptions. Fifth edition, thoroughly revised, by Thomas S. Wiegand, Ph. G. In one handsome octavo volume of 1093 pages, with 256 illustrations. Cloth, $5 ; leather, No thorough-going pharmacist will fail to possess himself of so useful a guide to practice, and no physician who properly estimates the value of an accurate knowledge of the remedial agents em- ployed by him in daily practice, so far as their miscibility, compatibility and mosteffective meth- ods of combination are concerned, can afford to leave this work out of the list of their works of reference. The country practitioner, who must always be in a measure his own pharmacist, will find it indispensable. — Louisville Medical News, March 29, 1884. This well-known work presents itself now based upon the recently revised new Pharmacopoeia. Each page bears evidence of the care bestowed upon it, and conveys valuable information from the rich store of the editor's experience. In fact, all that relates to practical pharmacy — apparatus, processes and dispensing — has been arranged and described with clearness in its various aspects, so as to atford aid and advice alike to the student and to the practical pharmacist. The work is judi- ciously illustrated with good woodcuts — American Journal of Pharmacy, January, 1884. There is nothing to equal Parrish's Pharmacy in this or any other language. — London Pharma^ eeutical Journal. JEEERMAmsr, JDr, i.. Professor of Physiology in the University of Zurich. Experimental Pharmacology. A Handbook of Methods for Determining the Physiological Actions of Drugs. Translated, with the Author's permission, and with extensive additions, by Robert Meade Smith, M. D., Demonstrator of Physiology in the University of Pennsylvania. In one handsome 12mo. volume of 199 pages, with 32 illustrations. Cloth, $1.50. MAISCJEC, JOSW^L, JPhar, D^, Professor of Materia Medica and. Botany in the Philadelphia College of Pharmacy. A Manual of Organic Materia Medica; Being a Guide to Materia Medica of the Vegetable and Animal Kingdoms. For the use of Students, Druggists, Pharmacists and Physicians. Third edition In one handsome royal 12mo. volume of about 550 pages, with about 250 illustrations. Shortly. BRUCE, J. MITCSELL, M. D., F. R. C. P., Physician and Lecturer on Materia Medica and Therapeutics at Charing Cross Hospital, London. Materia Medica and Therapeutics. An Introduction to Rational Treat- ment. Fourth edition. In one pocket-size 12mo. volume of 591 pages. Limji cloth, $1.50. See Students' Series of Manuals, page 4. GRIFFITHS, ROBERT EGLESFIELD, M, D, A Universal Formulary, containing the Methods of Preparing and Adminis- tering Officinal and other Medicines. The whole adapted to Physicians and Pharmaceut- ists. Third edition, thoroughly revised, with numerous additions, by John M. Maisch, Phar.D., Professor of Materia Medica and Botany in the Philadelphia College of Pharmacy. In one octavo volume of 775 pages, with 38 illustrations. Cloth, $4.50 ; leather, $5.50. 12 Lea Brothers & Co.'s Publications — Mat. Med., Therap. 8TILLB, A,, M. JD., LL. n., & MAISCS, J, M., JPhar,I>,, Prof, of Mat. Med. and Botany in Phila. College of Pharmacy, Sec^y to the Ameri- can Pharmaceutical Association. Professor Emeritus of the Theory and Prac tice of Medicine and of Clinical Medicine in the University of Pennsylvania. NEW (FOURTH) EDITION. The National Dispensatory. CONTAINING THE NATURAL HISTORY, CHEMISTRY. PHARMACY, ACTIONS AND USES OF MEDICINES, INCLUDING THOSE RECOGNIZED IN THE PHARMACOPdIAS OF THE UNITED STATES, GREAT BRITAIN AND GERMANY. WITH NUMEROUS REFERENCES TO THE FRENCH CODEX. Fourth edition, revised to October, 1886, and covering the new British Pharmacopeia. In one maiE^ificent imperial octavo volume of 1794 pages, with 311 elaborate engravings. Price in cloth, $7.25 : leather, raised bands, $8.00; very handsome half Russia, raised bands and open back, $9.00. *^* This work will be furnished with Patent Ready Reference Thumb-letter Index for $1.00 171 addition to the price in any style of binding. In this new edition of The National Dispensatory, all important changes in the recent British Pharmacopoeia have been incorporated throughout the volume, while in the Addenda will be found, grouped in a convenient section of 24 pages, all therapeutical novelties which have been established in professional favor since the publication of the third edition two years ago. Detailed information is thus given of the following among the many drugs treated: Antipyrin, Cocaine Hydrochlorate, Cascara Sagrada, Fabiana, Franciscea, various new Glycerins, Gymnocladus, Hydroquinon, Hypnone, lodol, Jaca- randa. Lanolin, Menthol, Pliormium, Sulphophenol, Thallin and Urethan. In this edition, as always before. The National Dispensatory may be said to be the represent- ative of the most recent state of American, English, German and French Pharmacology, Therapeutics and Materia Medica. The National Dispensatory is so well and favor- ably known on both sides of the Atlantic that scarcely anything else is left to the reviewer than to call attention to the fact that another edition of this valuable work has made Its appearance. This last edition surpasses even its predecessors in thoroughness and accuracy. The fact that in 1884, when the third edition was published, no revision of the British Pharmacopoeia had been made for seventeen years, has necessitated a thorough going over of the whole work in order that references might correspond to the last re- vision of the work of our British cousins. In addition to these changes is a fairly full resume, in the form of addenda, of the more important drugs which have come into general use in the last two or three yearS. — The American Journal of the Med- ical Sciences, April, 1887. This, the most comprehensive of the several commentaries on the Pharmacopoeias of the United States, Great Britain and Germany which has yet appeared, has by this last revision been brought fully up to the existing knowledge upon the sub- ject treated. Its references to the British Phar- macopceia have been amended for the late and much-changed new edition of that work; an "ad- denda" of twenty-five pages has been appended, treating of the latest and most important addi- tions to the materia medica. This work should be in the hands of every physician and pharma- cist. — Boston Medical and Surgical Journal, Feb. 10, 1887. We think it a matter for congratulation that the profession of medicine and that of pharmacy have shown such appreciation of this great work as to call for four editions within the comparatively brief period of eight years. The matters with which it deals are of so practical a nature that neither the physician nor the pharmacist can do without the latest text-books on them,especially those that are so accurate and comprehensive as this one. The book is in every way creditable both to the authors and to the publishers.— iNTew York Medical Journal^ May 21, 1887. FARQVHARSOl^, ROBEBT, M. D., Lecturer on Materia Medica at St. Mary's Hospital Medical School. A Guide to Therapeutics and Materia Medica. .Third American edition, Bpecially revised by the Author. Enlarged and adapted to the U. S. Pharmacopoeia by Frank Woodbury, M. D. In one handsome 12mo. volume of 524 pages. Cloth, $2.25. Dr. Farquharson's Therapeutics is constructed umned pages — one side containing the recognized upon a plan which brings before the reader all the phj'siological action of the medicine, and the other essential points with reference to the properties of the disease in which observers (who are nearly al- drugs. It impresses these upon him in such away ways mentioned) have obtained from it good, re- as to enable him to take a clear view of the actions suits — make a very good arrangement. The early of medicines and the disordered conditions in chapter containing rules for prescribing is excel- which they must prove useful. The double-col- , lent. — Canada Med. and Surg. Journal, Dec. 1882. JEDJES, BOBEMT T., M, J)., Jackson Professor of Clinical Medicine in Harvard University, Medical Department. A Text-Book of Materia Medica and Therapeutics. In one octavo volume of about 600 pages, with illustrations. In press. STIZLJE, AZFMJED, 31. 2>., LL. JD., Professor of Theory and Practice of Med. and of Clinical Med. in the Univ. of Penna. Therapeutics and Materia Medica. A Systematic Treatise on the Action and Uses of Medicinal Agents, including their Description and History. Fourth edition, revised and enlarged. In two large and handsome octavo volumes, containing 1936 pages. Cloth, $10.00; leather, $12.00; very handsome half Russia, raised bands, $13.00. Lea Brothers & Co.'s Publications — Pathol., Histol. 13 COATS, JOSJEJPM, M. !>., F, F, F, S., Pathologist to the Glasgow Western Infirmary. A Treatise on Pathology. In one very handsome octavo volume of 829 pages, with 339 beautiful illustrations. Cloth, $5.50 ; leather, $6.50. The work before us treats the subject of Path- | partment of medicine that is notas fully elucidated ology more extensively than it is u.sually treated In similar works. Medical students as well a? physicians, who desire a work for study or refer ence, that treats the subjects in the various de^ partments in a very thorough manner, but without as our present knowledge will admit. — Cincinnati Medical News, Oct. 1883. One of the best features of this realise consists in the judicious admixture of foreign observation with private experience. Thus the subject is prolixity, will certainly give this one the prefer- ! presented in a liarmonious manner, facilitating ence to any with which we are acquainted. It sets i the study of single topics and making the entire forth the most recent discoveries, exhibits, in an I volume profitable and pleasant reading. The interesting manner, the changes from a normal author includes in his descriptions, general condition effected in structures by disease, and I pathology as well as the special pathological histol- points out the characteristics of various morbid I ogy of the different systems and organs. He has agencies, so that they can be easily recognized. But, not limited to morbid anatomy,it explains fully how the functions of organs are disturbed by abnormal conditions. There is nothing belonging to its de- succeeded in offering to students and practition- ers a thoroughly acceptable work. — Medical Record, Dec. 22, 1883. GREEN, T. SE]!^IiT, M, !>., Lecturer on Pathologri and Morbid Anatomy at Charing-Cross Hospital Medical School, London.^ Pathology and Morbid Anatomy. Fifth American from the sixth revised and enlarged English edition. In one very handsome octavo volume of 482 pages, with 150 fine engravings. Cloth, $2.50 The fact that this well-known treatise has so rapidly reached its sixth edition is a strong evi- dence of its popularity. The author is to be con- gratulated upon the thoroughness with which he Has prepared this work. It is thoroughly abreast with all the most recent advances in pathology. No work in the English language Is so admirably adapted to the wants of the student and practi- tioner as this, and we would recommend it most earnestly to every one. — Nashville Journal of Medi- cine and Surgery, Nov. 1884. An extended review of such a well-known book is unnecessary. We had already regarded the- book as a model of its kind, and the author's as- surance that he believes the present edition to be' fully up to date will be received as sufficient, proof that nothing of importance has been omitted, The book has been most carefully revised, and bears upon every page the marks of the care and accuracy that have won for it an international reputation. — New York Medical and Surgical Jour- nal, July 18, 1885. WOODHEAD, G. SI31S, M. 2>., F. JR. C. JP. E., Demonstrator of Pathology in the University of Edinburgh. Practical Pathology. A Manual for Students and Practitioners. In one beau- tifiil octavo volume of 497 pages, with 136 exquisitely colored illustrations. Cloth, $6.00. •It forms a real guide for the student and practi- I themselves with this manual. The numerous tioner who is thoroughly in earnest in his en- | drawings are not fancied pictures, or merely deavor to see for himself and do for himself. To j schematic diagrams, but they represent faithfully the laboratory student it will be a helpful com- the actual images seen under the microscope, panion, and all those who may wish to familiarize ! The author merits all praise for having produced themselves with modern methods of examining | a valuable work. — Medical Record, May 31, 1884. morbid tissues are strongly urged to provide | SCHAFER, EDWARD A., F. R, S., Assistant Professor of Physiology in University College, London. The Essentials of Histology. In one octavo volume of 246 pages, with 281 illustrations. Cloth, $2.25. This admirable work was greatly needed. To those who are familiar with the author's former "Course of Practical Histology," the book needs no recommendation. It has been written with the object of supplying the student with directions for the microscopical examination of the tissue.=, which are given in a clear and understandable way. Although especially adapted for laboratory work, at the same time it is intended to serve as an elementary text-book of histology, comprising all the essential facts of the science, but omitting unimportant details. The author has recom- mended only those methods upon which long ex- perience has proved that full dependence can be placed. The strict observance of this plan per- mits of no doubt, and makes the work eminently satisfactory. — The Physician and Surgeon, July, ISSf. KLEIN, E., M, D., F. R. S., Joint Lecturer on General Anat. and Phys. in the Med. School of St. Bartholomew's Hosp., London. Elements of Histology. In one pocket-size 12mo. volume of 360 pages, with 181 illus. Limp cloth, red edges, $1.50. See Students' Series of Manimls, page 4. man body; and, while small in size, it is full to This little volume, originally intended by its able author as a manual for medical students, contains much valuable information, systematic- ally arranged, that will be acceptable to the general practitioner. It gives a graphic and lucid description of every tissue and organ in the hu- overflowing with important facts in regard to these multiform and complex structures. We know of no book of its size that will prove of greater value to medical students and practitioners of medi- cine. — The Southern Practitioner, Nov. 1883. PEFFER, A, J,, M. B., M, S,, F. R. C. S,, Surgeon and Lecturer at St. Mary's Hospital, London. Surgical Pathology. In one pocket-size 12mo. volume of 511 pages, illustrations. Limp cloth, red edges, $2.00. See Students' Series of Manuals, page 4, with 81 It is not pretentious, but it will serve exceed- ingly well as a book of reference. It embodies a great deal of matter, extending over the whole field of surgical pathology. Its form is practical, Its language is clear, and the information set forth is well-arranged, well-indexed and well- illustrated. The student will find in it nothing that is unnecessary. The list of subjects covers the whole range of surgery. The book supplies a very manifest want and should meet with suc- cess. — New York Medical Journal, May 31, 1884. Cornil and Ranvier's Pathological Histology. — Translated by E. O. Shakespeaee, M. D., and J. Henry C. Sime.s, M. D. Octavo, 800 pp., 360 illustrations. 14 Lea Brothers & Co.'s Publications — Practice of Med. FLINT, AUSTIN, M. D., Prof, of the Principles and Pi-actice of Med. and of Clin. Med. in Bellevve Hospital Medical College, N. Y. A Treatise on the Principles and Practice of Medicine. Designed for the use of Students and Practitioners of Medicine. New (sixth) edition, thoroughly re- vised and rewritten by the Author, assisted by William H. Welch, M. D., Professor of Pathology, Johns Hopkins University, Baltimore, and Austin Flint, Jr., M. D., LL. D., Professor of Physiology, Bellevue Hospital Medical College, N. Y. In one very handsome octavo volume of about 1170 pages, with illustrations. Cloth, |5.50 ; leather, $6.50 ; very handsome half Eussia, raised bands, $7.00. A new edition of a work of such established rep- utationas Flint's Medicine needs but few words to commend it to notice. It may in truth be said to embody the fruit of his labors in clinical medicine, ripened by the experience of a long life devoted to its pursuit. America may well be proud of having produced a man whose indefatigable industry and gifts of genius have done so much to advance med- icine ; and all English-reading students must be frateful for the work which he has left behind him. t has few equals, either in point of literary excel- lence, or of scientific learning, and no one'can fail to study its pages without being struck by the lu- cidity and accuracy which characterize them. It is qualities such as these which render it so valu- able for its purpose, and give it a foremost place among the text-books of this generation. — The London Lancet, March 12, 1887. No text-book on the principles and practice of medicine has ever met in this country with such general approval by medical students and practi- tioners as the work of Professor Flint. In all the medical colleges of the United States it is the fa- vorite work upon Practice; and, as we have stated before in alluding to it, there is no other medical work that can be so generally found in the libra- ries of physicians. In every state and territory of thisjvast country the book that will be most likely to be found in the office of a medical man, whether in city, town, village, or at some cross-roads, is Flint's Practice. We make this statement to a considerable extent from personal observation, and it is the testimony also of others. An examina- tion shows that very considerable changes have been made in the sixth edition. The work may un- doubtedly be regarded as fairly representing the present state of the science of medicine, and as reflecting the views of those who exemplify in their practice the present stage of progress of med- ical art. — Cincinnati Medical Newt, Oct. 1886. SARTSHOBNE, HENRY, M, D., LL, D., Lately Professor of Hygiene in the University of Pennsylvania. Essentials of the Principles and Practice of Medicine. A Handbook for Students and Practitioners. Fifth edition, thoroughly revised and rewritten. In one royal 12mo. volume of 669 pages, with 144 illustrations. Cloth, $2.75 ; half bound, $3.00. Within the compass of 600 pages it treats of the I this one; and probably, not one writer in our day history of medicme, general pathology, general ] had a better opportunity than Dr. Hartshorne for J. 1-1 j_ ■-_. ; i / ■ _ ,• condensing all the views of eminent practitioners into a 12mo. The numerous illustrations will be very useful to students especially. These essen- tials, as the name suggests, are not intended to supersede the text-books of Flint and Bartholow, but they are the most valuable in affording the means to see at a glance the whole literature of any disease, and the most valuable treatment. — Chicago Medical Journal and Examiner, April, 1882. symptomatology, and physical diagnosis (mcluding laryngoscope, ophthalmoscope, etc.), general ther- apeutic?, nosology, and special pathology and prac- tice. There is a wonderful amount of information contained in this work, and it is one of the best of its kind that we have seen. — Glasgow Medical Journal, Nov. 1882. An indispensable book. No work ever exhibited a better average of actual practical treatment than BBISTOWE, JOHN STEM, M, !>., E. It. C, P., Physician and Joint Lecturer on Medicine at St. Thomas' Hospital, London. A Treatise on the Practice of Medicine. Second American edition, revised by the Author. Edited, with additions, by James H. Hutchinson, M.D., physician to the Pennsylvania Hospital. In one handsome octavo volume of 1085 pages, with illustrations. Cloth, $5.00 ; leather, $6.00 ; very handsome half Russia, raised bands, $6.50. The book is a model of conciseness, and com- I and practice, as skin diseases, syphilis and insan- bines, as successfully as one could conceive it to be possible, an encyclopsedic character with the smallest dimensions. It differs from other admi- rable text-books in the completeness with which it covers the whole field of medicine. — Michigan Medical Neics, May 10, 1880. His accuracy in the portraiture of disease, his care in stating subtle points of diagnosis, and the faithfully given pathology of abnormal processes have seldom been surpassed. He embraces many diseases not usually considered to belong to theory ity, but they will not be objected to by readers, as he has studied them conscientiously, and drawn from the life. — Medical and Surgical Reporter, De- cember 20, 1879. The reader will find every conceivable subject connected with the practice of medicine ably pre- sented, in a style at once clear, interesting and concise. The additions made by Dr. Hutchinson are appropriate and practical, and greatly acW to its usefulness to American readers. — Buffalo Med- ical and Surgical Journal, March, 1880. WATSON, SIB THOMAS, M, I>., Late Physician in Ordinary to the Queen. Lectures on the Principles and Practice of Physic. A new American from the fifth English edition. Edited, with additions, and 190 illustrations, by Henby Haktshorne, a. M., M. D., late Professor of Hygiene in the University of Pennsylvania. In two large octavo volumes of 1840 pages. Cloth, $9.00 ; leather, $11.00. LECTURES ON THE STUDY OF FEVER. By A. HxTDSON, M. D., M. R. I. A. In one octavo volume of 308 pages. Cloth, $2.50. STOKES' LECTURES ON FEVER. Edited by John William Moore, M. D., F. K. Q. C. P. In one octavo volume of 280 pages. Cloth, $2.00. A TREATISE ON FEVER. By Robert D. Lyons, K. C. C. In one 8vo. vol. of 354 pp. Cloth, 82.26. LA ROCHE ON YELLOW FEVER, considered in its Historical, Pathological, Etiological and Therapeutical Relations. In two large and hand- some octavo volumes of 1468 pp. Cloth, 87.00. A CENTURT OF AfllERICAN MEDICINE, 1776—1876. By Drs. E. H. Clabkb, H. J. BiQELOw, S. D. Geoss, T. G. Thomas, and J. S. Billings. In one 12mo. volume of 370 pages. Cloth, $2.25. Lea Brothers & Co.'s Publications — System of Med. 15 For Sale by Suhscriiytion Only. A System of Practical Medicine. BY AMERICAN AUTHORS. Edited by WILLIAM PEPPER, M. D., LL. D., PROVOST AND PROFESSOR OF THE THEORY AND PRACTICE OP MEDICINE AND OF CLINICAL MEDICINE IN THE UNIVERSITY OF PENNSYLVANIA, Assisted by Louis Starr, M. D., Clinical Professor of the Diseases of Children in the Hospital of the University of Pennsylvania. The complete work, in five volumes, containing 5573 pages, with 198 illustrations, is just ready. Price per volume, cloth, $5 ; leather, $6 ; half Russia, raised bands and open back, $7. In this great work American medicine is for the first time reflected by its worthiest teachers, and presented in the full development of the practical utility which is its pre- eminent characteristic. The most able men — from the East and the West, from the North and the Soi*th, from all the prominent centres of education, and from all the hospitals which afford special opportunities for study and practice — have united in generous rivalry to bring together this vast aggregate of specialized experience. The distinguished editor has so apportioned the work that to each author has been assigned the subject which he is peculiarly fitted to discuss, and in which his views will be accepted as the latest expression of scientific and practical knowledge. The practitioner will therefore find these volumes a complete, authoritative and unfailing work of reference, to which he may at all times turn with full certainty of finding what he needs in its most recent aspect, Avhether he seeks information on the general principles of medi- cine, or minute guidance in the treatment of special disease. So wide is the scope of the work that, with the exception of midwifery and matters strictly surgical, it embraces the whole domain of medicine, including the departments for which the physician is accustomed to rely on special treatises, such as diseases of women and children, of the genito-urinary organs, of the skin, of the nerves, hygiene and sanitary science, and medical ophthalmology and otology. Moreover, authors have inserted the formulas which they have found most efficient in the treatment of the various affections. It may thus be truly regarded as a Complete Library of Practical Medicine, and the general practitioner possessing it may feel secure that he will require little else in the daily round of professional duties. In spite of every effort to condense the vast amount of practical information fur- nished, it has been impossible to present it in less than 5 large octavo volumes, containing about 5600 beautifully printed pages, and embodying the matter of about 15 ordinary octavos. Illustrations are introduced wherever requisite to elucidate the text. A detailed prospectus will be sent to any address on application to the publishers. These two volumes bring this admirable work to a close, and fully sustain the high standard reached by the earlier volumes ; we have only therefore to echo the eulogium pronounced upon them. We would warmly congratulate the editor and his collaborators at the conclusion of their laborious task on the admirable manner in which, from first to last, they have performed their several duties. They have succeeded in producing a work which will long remain a standard work of reference, to which practitioners will look for fuidance, and authors will resort to for facts, rem a literary point of view, the work is without any serious blemish, and in respect of production, it has the beautiful finish that Americans always give their works. — Edinburgh MedicalJournal, Jan. 1887. * * The greatest distinctively American work on the practice of medicine, and, indeed, the super- lative adjective would not be inappropriate were even all other productions placed in comparison. An examination of the five volumes is sufficient to convince one of the magnitude of the enter- prise, and of the success which has attended its fulfilment.— jT/je Medical Age, July 26, 1880. This huge volume forms a fitting close to the great system of medicine which in so short a time has won so high a place in medical literature, and has done such credit to the profession in this country. Among the twenty-three contributors are the names of the leading neurologists in America, and most of the work in the volume is of the highest order. — Boston Medical and Surgical Journal, July 21, 1887. We consider it one of the grandest works on Practical Medicine in the English language. It is a work of which the profession of this country can feel proud. Written exclusively by American physicians who are acquainted with all the varie- ties of climate in the United .States, the character of the soil, the manners and customs of the peo- ple, etc., it is peculiarly adapted to the wants of American practitioners of medicine, and it seems to us that every one of them would desire to have it. It has been truly called a "Complete Library of Practical Medicine," and the general practitioner will require little else in his round of professional duties. — Cincinnati Medical News, March, 1886. Each of the volumes is provided with a most copious index, and the work altogether promi.ses to be one which will add much to the medical literature of the present century, and reflect great credit upon the scholarship and practical acumen of its authors. — The London Lancet, Oct. 3, 1885. The feeling of proud satisfaction with which the American profession sees this, its representative system of practical medicine issued to the medi- cal world, IS fully justified by the character of the work. The entire caste of the system is in keep- ing with the best thoughts of the leaders and fol- lowers of our home school of medicine, and the combination of the scientific study of disease and the practical application of exact and experimen- tal knowledge to the treatment o( human mal- adies, makes every one of us share in the pride that has welcomed Dr. Pepper's labors. Sheared of the prolixity that wearies the readers of the German school, the articles glean these same fields for all that is valuable. It is the outcome of American brains, and is marked throughout by much of the sturdy independence of thought and originality that is a national characteristic. Yet nowhere is there lack of study of the most advanced views of the day. — North Carolina Medi- cal Journal, Sept. 1886. 16 Lea Brothers & Co.'s Publications — Clinical Med., etc. FOTHEBGILL, J. 31., M. J>., JEdifi,, M, B, C. P., Lond,, Physician to the City of London Hospital for Diseases of the Chest. The Practitioner's Handbook of Treatment ; Or, The Principles of Thera- peutics. New (third) edition. In one octavo volume of 661 pages. Cloth, $3.75 ; leather, $4.75. Just ready. Dr. Fothergillis always interesting and instruct- ive, and in this standard work he shows his peculiar power as a writer on therapeutics to the best advantage. Everything he undertakes is done conscientiously. The book well sustains greatly increased by the introduction of many prescriptions. That the profession appreciates that the author has undertaken an important work and lias accomplished it is shown by the demand for this third edition. — New York %il'edicalJournal, the favorable impression which it created at the j June 11, 1887. beginning of its career, and in its present im- This is a wonderful book. If there be such a proved form it will be welcomed more than ever . thing as "medicine made easj'," this is the work by the busy practitioner and the scientific student | to accomplish this result. It imparts information of medicine.— The Medical Kews, July 23, 1887. j so agreeably, so smoothly, that the reader almost To have a description of the normal physiologi- i thinlcs as he lays the book down that he "knew cal processes of an organ and of the methods of I that before," when in reality he did not, or else he treatment of its morbid conditions brought I could before have reconciled facts which now together in a single chapter, and the relations ; become clear as daylight. The author deals with between the two clearly stated, cannot fail to prove i the "Principles of Therapeutics," the study of a great convenience to many thoughtful but busy i which will give great vantage to the physician. — physicians. The practical value of the volume is i Virginia Medical Monthly, June, 1887. BEYJSrOLDS, J. RUSSBLL, M. D., Professor of the Principles and Practice of Medicine in University College, London. A System of Medicine. With notes and additions by HTenry Hartshorne, A. M., M. D., late Professor of Hygiene in the University of Pennsylvania. In three large and handsome octavo volumes, containing 3056 double-columned pages, with 317 illustra- tions. Price per volume, cloth, $5.00 ; sheep, $6.00 ; very handsome half Russia, raised bands, $6.50. Per set, cloth, $15; leather, $18 ; half Russia, $19.50. Sold only by subscnption. STILLB, ALFJRJED, M, D., LL, 2)., Professor Emeritus of the Theory and Practice of Med. and of Clinical Med. in the Univ. of Penna. Cholera : Its Origin, History, Causation, Symptoms, Lesions, Prevention and Treat- ment. In one handsome 12mo. volume of 163 pages, with a chart. Cloth, $1.25. Just ready. FINLAYSON, JAMES, M. D., Editor, Physician and Lecturer on Clinical Medicine in the Olasgow Western Infirmary, etc. Clinical Manual for the Study of Medical Cases. With Chapters by Prof. Gairdner on the Physiognomy of Disease; Prof. Stephenson on Diseases of the Female Organs; Dr. Robertson on Insanity; Dr. Gemmell on Physical Diagnosis; Dr. Coats on Laryngoscopy and Post-Mortem Examinations, and by the Editor on Cftse- taking. Family History and Symptoms of Disorder in the Various Systems. New edition. In one 12mo. volume of 682 pages, with 158 illustrations. Cloth, $2.50. Just ready. The profession cannot but welcome the second edition of this very valuable work of Finlayson and his collaborators. The size of the book has been increased and the number of illustrations nearly doubled. The manner in which the sub- and a siudy of means to the end whijh cannot fail in laying an excellent foundation for the student for future success as an able diagnostician. — Medical Record, August 13, 1887. The second edition of this manual is a very ject is treated is a most practical one. Symptoms ccn'>iderable improvement upon the first. Much alone and their diagnostic indications "form the ! new matter has been introduced and the work has basis of discussion. The text explains clearly and i been brought up to the present time in all r«-speets. thoroughly the methods of examination and the | As it stands it is one of the best manuals of diag- conclusions to be drawn from the physical signs. — i nosis in the English language for beginners. The The Medical News, .\pril 23, 1887. * I whole work is so complete and so simply written. This manual is one of the most complete and i and yet contains such an amount of valuable perfect of its kind. It goes thoroughly into the , information, that it should be a part of the library question of diagnosis from every po.'^sible point, of every practitioner. — New York Medical Journal, It must lead to a thoroughness of observation, an ' July 23, 1887. examination in detail of every scientific appliance, I FENWICK, SAJSrUEL, 31. £>., Assistant Phystcian to the London Hospital. The Student's Guide to Medical Diagnosis. From the third revised and enlarged English edition. In one very handsome royal 12mo. volume of 328 pages, with 87 illustrations on wood. Cloth, $2.25. MABEBSELOJ!^, S. O., 31. D., Senior Physician to and late Lect. on Principles and Practice of Med. at Oity's Hospital, Lo'ndon. On the Diseases of the Abdomen ; Comprising those of the Stomach, and other parts of the Alimentary Canal, OEsophagus, Csecum, Intestines and Peritoneum. Second American from third enlarged and revised English edition. In one handsome octavo volume of 554 pages, with illustrations. Cloth, $3.50. TAKIf^EB, TJlOJtTAS MAWKES, 31. JD. A Manual of Clinical Medicine and Physical Diagnosis. Third American from the second London edition. Revised and enlarged by Tixbury Fox, M. D. In one small 12mo. volume of 362 pages, with illustrations. Cloth, $1.50. Lea Brothers & Co.'s Publications — Hygriene, Electr., Pract. 17 BABTHOLOW, JtOBJEMTS, A, M,, M. J)., ii. !>., Prof, of Materia Medica and General Therapeutics in the Jefferson Med. Coll. of Phila., etc. Medical Electricity. A Practical Treatise on the Applications of Electricity to Medicine and Surgery. New (third) edition. In one very handsome octavo volume of 308 pages, with 110 illustrations. Cloth, $2.50. Just ready. The fact that this work has reached its third edi- tion in six years, and that it has been kept fully abreast with the increasing use and knowledge of electricity,deu-ionstrates its claim to be considered a practical treatise of tried value to the profession. The matter added to the present edition embraces the most recent advances in electrical treatment. The illustrations are abundant and clear, and the work constitutes a full, clear and concise manual well adapted to the needs of both student and practitioner.— T/(e Medical News, May 14, 1887. This "practical treatise on the applications of electricity to medicine and surgery" has grown to be so important a work that every practitioner should read it, especially when it is recalled what possibilities lie in the path of the further study of the therapeutics of electricity. Dr. Bartholow has here presented the profession with a concise work that, beginning with elementary description.s and principles, gradually grows, page by page, into a magnificently practical treatise, descrihing opera- tions in detail, and giving records of successes that prove electricity to be marvellous as a curative agent in many forms of disease. The doctor can- not now do better than to possess himself of Dr. Bartholow's treatise, just as it is. — Virginia Medi- cal Monthly, June, I8ii7. mCSABDSOJ!^, B. W., M.A., M,I>., LL, J>., F.M,S,, F,S.A. Fellow of the Royal College of Phi/siciaihs, fondon. Preventive Medicine. In one octavo volume ot 729 pages. $5; very handsome half Eus-sia, raised bands, $5.50. Cloth, $4; leather, Dr. Richardson has succeeded in producing a work which is elevated in conception, comprehen- sive in scope, scientific in character, systematic in arrangement, and which is written in a clear, con- cise and pleasant manner. He evinces the happy faculty of extracting the pith of what is known on the subject, and of presenting it in a most simple, intelligent and practical form. There is perhaps no similar work written for the general public thatcontains such acomplete, reliable and instruc- tive collection of data upon the diseases common to the race, their origins, causes, and the measures for their prevention. The descriptions of diseases are clear, chaste and scholarly; the discussion of the question of disease is comprehensive, masterly and fully abreast with the latest and best knowl- edge on the subject, and the preventive measures advised are accurate, explicit and reliable. — The American Journal of the Medical Sciences, April, 1884. HABTSHOBNB, MENMY, M. I)., LL. I)., Formerly Professor of Hygiene in the University of Pennsylvania, and Professor of Physiology and Diseases of Children in the Wovian's Medical College of Pennsylvania. A Household Manual of Medicine, Surgery, Nursing and Hygiene: For Daily Use in the Preservation of Health and Care of the Sick and Injured, with an Introductory Outline of Anatomy and Physiology. In one very handsome royal octavo volume of 946 pages, with 8 plates and 283 engravings. Cloth, $4.00 ; very handsome half Morocco, $5.00. __^__ TML: YEAB-BOOK of TBEATMENT fob 1886. A Comprehensive and Critical Review for Practitioners of Medi- cine. In one 12mo. volume of 309 pages, bound in limp cloth, $1.25. every practitioner, whether he be a general one or a specialist. It is a book to be kept on the office table for continuous reference. An excellent in- dex to subjects, as well as to authors quoted, is appended. — Virginia Bledical Monthly, April, 1S87. This "review" includes every department of medical and surgical as well as obstetrical practice. It attempts nothing in the way of etiology, diag- nosis or symptoms, but limits itself to the ad- vances made in the treatment of diseases, injuries, etc. The work seems to us to be invaluable to * -X- For special commutations with periodicals see page 3. THE YEAB-BOOK OF TBEATMENT FOB 1885. Similar to that of 1886 above. 12mo., 320 pages. Limjj cloth, $1.25. SCHBEIBEB, DB. JOSEFEL. A Manual of Treatment by Massage and Methodical Muscle Ex- ercise. Translated by Walter Mendelson, M. D., of New York. In one handsome octavo volume of 278 pages, with 117 tine engravings. Just ready. Cloth, $2.75. The present volume will do much to establish mechanical therapeutics upon a scientific basis. The vvork is a very welcome addition to the library, and we heartily recommend it to our readers as a step in the right direction. — New York Medical Journal, July IG, 1887. As a thorough and satisfactory exposition of the science of mechanical therapeutics, adapted to the use of the general practitioner, this volume leaves nothing to be desired. The text is fully illustrated by well-drawn woodcuts, leaving no room for obscurity in the description of the vari- ous manipulations recommended. — Atlanta Medi- cal and Surgical Journal, Aug. 1887. 8TURGES' INTRODUCTION TO THE STUDY OF CLINICAL MEDICINE. Being a Guide to the Investigation of Disease. In one handsome 12mo. volume of 127 pages. Cloth, 81.25. DAVIS' CLINICAL LECTURES ON VARIOUS IMPORTANT DISEASES. By N. S. Davis, M. D. Edited by Frank H. Davis, M. D. Second edition. 12mo. 287 pages. Cloth, 81.75. TODD'S CLINICAL LECTURES ON CERTAIN ACUTE DISEASES. In one octavo volume of 320 pages. Cloth, 82.50. PAVY'S TREATISE ON THE FUNCTION OF DI- GESTION; its Disorders and their Treatment. From the second London edition. In one octavo vohime of 238 pages. Cloth, $2.fKI. BARLOW'S MANUAL OF THE PRACTICE OF MEDICINE. With additions by D. F. Cokdib, M. D. 1 vol. 8vo., pp. 60.3. Cloth, S2.50. CHAMBERS' MANUAL OF DIET AND REGIMEN IN HEALTH AND SICKNESS. In one hand- some octavo volume of 302 pp. Cloth, 82.75. HOLLAND'S MEDICAL NOTES AND REFLEC- TIONS. 1 vol. 8vo., pp. 493. Cloth, $3.50. 18 Lea Brothers & Co.'s Publications — Tliroat, liimgs. Heart, FLINT, AUSTIN, M. J>., Professor of the Principles and Practice of Medicine in Bellevue Hospital Medical College, N. Y. A. Manual of Auscultation and Percussion ; Of the Physical Diagnosis of Diseases of the Lungs and Heart, and of Thoracic Aneurism. Fourth edition. In one handsome royal 12mo. volume of 278 pages, with 14 illustrations. Cloth, $1.75. This admirable little book is too well known to j study. Dr. Flint's work is iust such a book. It require any extended notice. That a third and i contains the substance of the lessons which the large edition has been exhausted in little more ! author has for many years given in connection than two years, is evidence that the book is appre- ! with practical instruction in auscultation and ciated. We ourselves have used a former edition j percussion to private classes, composed of medical as a text-book in teaching the physical examina- I students and practitioners. The fact that within tion of the chest, and can consequently speak from : a little more than two years a large edition of this experience.— Boston Medical and Surgical Journal, manual has been exhausted, is proof of the favor Feb. 11, 1886. with which it has been regarded by the medical The student needs a first-class text-book in 1 profession. — Cincinnati Medical News, Feb. 1886. which the subject is fully explained for him to j BY THE SAME AUTHOR. Physical Exploration of the Lungs by Means of Auscviltation and Percussion. Three lectures delivered before the Philadelphia County Medical Society, 1882-83. In one handsome small 12mo. volume of 83 pages. Cloth, $1.00. A Practical Treatise on the Physical Exploration of the Chest and the Diagnosis of Diseases Affecting the Respiratory Organs. Second and revised edition. In one handsome octavo volume of 591 pages. Cloth, $4.50. Phthisis: Its Morbid Anatomy, Etiology, Symptomatic Events and Complications, Fatality and Prognosis, Treatment and Physical Diag- nosis ; In a series of Clinical Studies. In one handsome octavo volume of 442 pages. Cloth, $3.50. A Practical Treatise on the Diagnosis, Pathology and Treatment of Diseases of the Heart. Second revised and enlarged edition. In one octavo volume of 550 pages, with a plate. Cloth, $4. Essays on Conservative Medicine and Kindred Topics. In one very hand- some royal 12mo. volume of 210 pages. Cloth, $1.38. GROSS, S. !>., jr.jD., LL.D., D.C.L. Oxon., LL.I>. Cantab. A Practical Treatise on Foreign Bodies in the Air-passages. In one octavo volume of 452 pages, with 59 illustrations. Cloth, $2.75. COHEN, J. SOLIS, M, n.. Lecturer on Laryngoscopy ajid Diseases of the Throat and Chest in the Jefferson Medical College. Diseases of the Throat and Nasal Passages. A Guide to the Diagnosis and Treatment of Affections of the Pharynx, CEsophagus, Trachea, Larynx and Nares. Third edition, thoroughly revised and rewritten, with a large number of new illustrations. In one very handsome octavo volume. Preparing. SBILBB, CARL, 31. D., Lecturer on Laryngoscopy in the University of Pennsylvania. A Handbook of Diagnosis and Treatment of Diseases of the Throat, Nose and Naso-Pharynx. Second edition. In one handsome royal 12mo. volume of 294 pages, with 77 illustrations. Cloth, $1.75. and there are a valuable bibliography and a good index of the whole. For any one who wishes to make himself familiar with the practical manage- It is one of the best of the practical text-books on this subject with which we are acquainted. The present edition has been increased in size, but its eminently practical character has been main- tained. Many new illustrations have also been introduced, a case-record sheet has been added. ment of cases of throat and nose disease, the book will be found of great value. — New York Medical Journal, June 9, 1883. BROADBJENT, W. M., M. D., F. R. C. B., Phitsician to and Lecturer on Medicine at St. Mary's Hospital. The Pulse. In one 12mo. volume. Preparing. See Series of Clinical Manuah, page 4. FULLER ON DISEASES OF THE LUNGS AND AIR-PASSAGES. Their Pathology, Physical Di- agnosis, Symptoms and Treatment. From the second and revised English edition. In one octavo volume of 475 pages. Cloth, 83.50. BLADE ON DIPHTHERIA; its Nature and Treatr ment, with an account of the History of its Pre- valence in various Countries. Second and revised SMITH ON CONSUMPTION; its Early and Reme- diable stages. 1 vol. 8vo., pp. 253. Cloth, $2.25. LA ROCHE ON PNEUMONIA. 1 vol. 8vo. of 490 pages. Cloth, $3.00. WILLIAMS ON PULMONARY CONSUMPTION; its Nature, Varieties and Treatment. With an analysis of one thousand cases to exemplify its duration. In one 8vo. vol. of 303 pp. Cloih, 82.50. edition. In one 12mo. vol., pp. 158. Cloth, 81.25. | JONES' CLINICAL OBSERVATIONS ON FUNC- WALSHE ON THE DISEASES OF THE HEART I TIONAL NERVOUS DISORDERS. Second Am- AND GREAT VESSELS. Third American edi- 1 erican edition. In one handsome octavo volume tion. In 1 vol. 8vo., 416 pp. Cloth, 83.00. | of 340 pages. Cloth, $3.25. Lea Brothers & Co.'s Publications — Nerv. audMeiit. Dis., etc. 19 BOSS, JAMES, M. Z)., JF, JR. C. P., ZL. J)., Senior Assistant Physician to the Manchester Royal Infirmary. A Handbook on Diseases of the Nervous System. In one octavo volume of 725 pages, with 184 illustrations. Cloth, $4.50 ; leather, $5.50. This admirable work is intended for students of ] the department of medicine of which it treats, medicine and for such medical men as have no time ! Dr. Ross holds such a high scientific position that for lengthy treatises. In the present instance the i any writings which bear his name are naturally duty of arranging the vast store of material at the ' expected to have ths impress of a powerful intel- disposal of the author, and of abridging the de- ', lect. In every part this handbook merits the scription of the different aspects of nervous dis- | highest praise, and will no doubt be found of the eases, has been performed with singular skill, and 1 greatest value to the student as vrell as to the prac- the result is a concise and philosophical guide to 1 titioner. — Edinburgh Medical Journal, Jan. 1887. MITCHELL, S. WEIB, M. D., Physician to Orthopvedic Hospital ami the Infirmary for Diseases of the Nervous System, Phila., etc. Lectures on Diseases of the Nervous System; Especially in Women. Second edition. In one 12mo. volume of 288 pages. Cloth, $1.75. No work in our language develops or displays more features of that many-sided alTection, hys- teria, or gives clearer directions for its difieren- tiation, or sounder suggestions relative to its general management and treatment. The book IS particularly valuable in that it represents in the main the author's own clinical studies, which have been so extensive and fruitful as to give his teachings the stamp of authority all over the realm of medicine. The work, although written by a specialist, has no exclusive character, and the general practitioner above all others will find its perusal profitable, since it deals witli diseases which he frequently encounters and must essay to treat. — American Practitioner, August, 1885. HAMILTON, ALLAJf McLAJSTE, M, H., Attending Physician at the Hospital for Epileptics and Paralytics, BlackioeWs Island, N. 7. Nervous Diseases ; Tlieir Description and Treatment. Second edition, thoroughly revised and rewritten. In one octavo volume of 598 pages, with 72 illustrations. Cloth, $4. When the first edition of this good bookappeared we gave it our emphatic endorsement, and the E resent edition enhances our appreciation of the ook and its author as a safe guide to students of clinical neurology. One of the best and most critical of English neurological journals, Brain, has characterized this book as the best of its kind in any language, which is a handsome endorsement from an exalted source. The improvements in the new edition, and the additions to it, will justify its purchase even by those who possess the old. — Alienist and Neurologist, April, 1882. TUKE, DANIEL HACK, 31, D., Joint Author of The Manual of Psychological Medicine, etc. Illustrations of the Influence of the Mind upon the Body in Health and Disease. Designed to elucidate the Action of the Imagination. New edition. Thoroughly revised and rewritten. In one handsome octavo volume of 467 pages, with two colored plates. Cloth, $3.00. It is impossible to peruse these interesting chap- ters without being convinced of the author's per- fect sincerity, impartiality, and thorough mental grasp. Dr. Tuke has exhibited the requisite amount of scientific address on all occasions, and the more intricate the phenomenathe more firmly has he adhered to a physiological and rational method of interpretation. Guided by an enlight- ened deduction, the author has reclaimed for science a most interesting domain in psychology, previously abandoned to charlatans and empirics. This book, well conceived and well written, must commend itself to every thoughtful understand- ing. — New York Medical Journal, September 6, 1884. CLOJJSTON, THOMAS S,, M. I)., F, B, C, P,, L, B, C. S., Lecturer on Mental Diseases in the University of Edinburgh. Clinical Lectures on Mental Diseases. With an Appendix, containing an Abstract of the Statutes of the United States and of the Several States and Territories re- lating to the Custody of the Insane. By Charles F. Folsom, M. D., Assistant Professor of Mental Diseases, Med. Dep. of Harvard Univ. In one handsome octavo volume of 541 pages, with eight lithographic plates, four of which are beautifully colored. Cloth, $4. The practitioner as well as the student will ac- cept the plain, practical teaching of the author as a forward step in the literature of insanity. It is refreshing to find a physician of Dr. Clouston's experience and high reputation giving the bed- side notes upon which his experience has been founded and his mature judgment established. Such clinical observations cannot but be useful to the general practitioner in guiding him to a diag- nosis and indicating the treatment, especially in many obscure and doubtful cases of mental dis- ease. To the American reader Dr. Folsom's Ap- pendix adds greatly to the value of the work, and will make it a desirable addition to every library. — American Psychological Journal, July, 1884. 108 pages. •. Folsom's Abstract may also be obtained separately in one octavo volume of Cloth, $1.50. SAVAGE, GEOBGE H., M. H., Lecturer on Mental Diseases at &uy^s Hospital, London. Insanity and Allied Neuroses, Practical and Clinical. In one 12mo. vol. of 551 pages, with 18 illus. Cloth, $2.00. See Series of Clinical Manuals, page 4. PLATE ALB, W, S., M, I)., E. B. C. JP. The Systematic Treatment of Nerve Prostration and Hysteria. In one handsome small 12mo. volume of 97 pages. Cloth, $1.00. Blandford on Insanity and its Treatment: Lectures on the Treatment, Medical and Legal, of Insane Patients. In one very handsome octavo volume. 20 Lea Brothers & Co.'s Publications — Surgery. ASSBJTItST, JOSIf, Jr., M. D., Professor of Clinical Surgery, Univ. of Penna., Surgeon to the Episcopal Hospital, Philadelphia. The Principles and Practice of Surgery. New (fourth) edition, enlarged and revised. In one large and handsome octavo volume of 1114 pages, with 597 illustra- tions. Cloth, $6 ; leather, $7 ; half Eussia, $7.50. As with Erichsen so with Ashhurst, its position in professional favor is established, and one has now but to notice the changes, if any, in theory and practice, that are apparent in the present as compared with the preceding edition, published three years ago. The work has been brought well up to date, and is larger and better illustrated than before, and its author may rest assured that it will certainly have a " continuance of the favor with which it has heretofore been received."— TAe American Journal of the Medical Sciences, Jan. 1886. Every advance in surgery worth notice, chroni- cled in recent literature, has been suitably recog- nized and noted in its proper place. Suffice it to say, we regard Ashhurst's Surgery, as now pre- sented in the fourth edition, as the best single volume on surgery published in the English lan- guage, valuable alike to the student and the prac- titioner, to the one as a text-book, to the other aa a manual of practical surgery. With pleasure we give this volume our endorsement in full. — New Orleans Medical and Surgical Journal, Jan., 1886. GMOSS, S. D., M, JD., LL, J)., jD. C. i. Oxon., LL, J>. Cantab., Emeritus Professor of Surgery in the Jefferson Medical College of Philadelphia. A System of Surgery : Pathological, Diagnostic, Therapeutic and Operative. Sixth edition, thoroughly revised and greatly improved. In two large and beautifully- printed imperial octavo volumes containing 2382 pages, illustrated by 1623 engravings. Strongly bound in leather, raised bands, $15 ; half Russia, raised bands, $16. His System of Surgery, which, since its first edi- tion in 1859, has been a standard work in this Dr. Gross' St/stem of Surgery has long been the standard work on that subject for students and practitioners. — London Lancet, May 10, 1884. The work as a whole needs no commendation. Many years ago it earned for itself the enviable reputation of the leading American work on sur country as well as in America, in "the whole domain of surgery," tells how earnest and labori- ous and wise a surgeon he was. how thoroughly he appreciated the work done by men in other gery, and it is still capable of maintaining that countries, and how much he contributed to pro- standard. A considerable amount of new material j mote the science and practice of surgery in his has been introduced, and altogether the distin- i own. There has been no man to whom America guished author has reason to be satisfied that he I is so much indebted in this respect. as the Nestor has placed the work fully abreast of the state of I of surgery. — British Medical Journal, May 10, 1884. our knowledge. — Med. Record, Nov. 18, 1882. I DBUITT, ROBERT, M. It. C. S., etc. Manual of Modern Surgery. Twelfth edition, thoroughly revised by Stan- ley Boyd, M. B., B. S., F. R. C. S. In one 8vo. volume of 965 pages, with 373 illustra- tions. Cloth, $4 ; leather, $5. FROM THE EDITOR'S PREFACE TO THE TWELFTH EDITION. Few works have been more widely known and appreciated than Druitt's "Surgery." In England I am informed that 50,000 copies have been sold, whilst in America it has been so highly appreciated that a copy was issued by the Government to each surgeon serving in the Federal Army during the great Civil War. The twelfth edition difl'ers much from the eleventh ; scarcely a paragraph of the latter remains unaltered. In spite of my utmost endeavors to compress, the book has increased consideraljly in size. This is due to many causes, especially to the greatly increased range of subjects with which I have had to deal, to the replacement of many old illustrations by a number of consider- ably larger ones, and to the addition of a copious index. GIBNBY, V. B., M. JD., Surgeon to the Orthopcedie Hospital, New York, etc. Orthopaedic Surgery. For the use of Practitioners and Students, some octavo volume, profusely illustrated. Preparing. In one hand- BOBBBTS, JOBT]^ B., A. 31., M. JD., Lecttirer on Anatomy and on Operative Surgery at the Philadelphia School of Anatomy. The Principles and Practice of Modern Surgery. For the use of Students and Practitioners of Medicine and Surgery. In one very handsome octavo volume of about 500 pages, with many illustrations. Preparing. BELLA3IT, BDWABJD, F. B. C. S., Surgeon and Lecturer on Surgery at Charing Cross Hospital, London. Operative Surgery. Shortly. See Students' Series of Manuals, page 4. BALL, CMABLBS B., M. Ch., Bub., F. B. C. S. B., Surgeon and Teacher at Sir P. Dun's Hospital, Dublin. Diseases of the Kectum and Anus. In one 12mo. volume of 550 pages. Preparing. See Series of Clinical Manuals, page 4. MILLER'S PRACTICE OF SURGERY. Fourth MILLER'S PRINCIPLES OF SURGERY. Fourth and revised American from the last Edinburgh American from the third Edinburgh edition. In edition. In one large 8vo. vol. of 682 pages, with one 8vo. vol. of 638 pages, with 340 illustrations. 364 illustrations. Cloth, S3.76. Cloth, $3.76. Lea Brothers & Co.'s Publications — Surgery. 21 EBICMSEJS^, JOHN E., F. It. S., F, M. C. S., Professor of Surgery in University College, London, etc. The" Science and Art of Surgery ; Being a Treatise on Surgical Injuries, Dis- eases and Operations. From the eighth and enlarged English edition. In two large and beautiful octavo volumes of 2316 pages, illustrated with 984 engravings on wood. Cloth, $9; leather, raised bands, $11 ; half Russia, raised bands, $12. In noticing the eighth edition of this well- known work, it would appear superfluous to say more than that it has, like its predecessors, been brought fully up to the, times, and is in conse- quence one of the best treatises upon surgery that has ever been penned by one man. We nave al- ways regarded "The Science and Art of Surgery" as one of the best surgical text-books in the English language, and this eighth edition only confirms our previous opinion. We take great pleasure in cordially commending it to our read- ers.— TOeiV/edicni Neics, April 11, 1885. After being before the profession for thirty years and maintaining during that period a re- putation as a leading work on surgery, there is not much to be said in the way of comment or criti- cism. That it still holds its own goes without say- ing. The author infuses into it his large experi- ence and ripe judgment. Wedded to no school, committed to no theory, biassed by no hobby, he imparts an honest personality in his observations, and his teachings are the rulings of an impartial judge. Such men are always safe guides, and their works stand the tests of time and experience. Such an author is Brichsen, and such a work is his Surgery. — Medical Record, Feb. 21, 1885. BMYANT, THOMAS, F. JR. C. S., Surgeon and Lecturer on Surgery at Guy's Hospital, London. The Practice of Surgery. Fourth American from the fourth and revised Eng- lish edition. In one large and very handsome imperial octavo volume of 1040 pages with 727 illustrations. Cloth, $6.50; leather, $7.50; half Russia, $8.00. boolts for the medical student. Almost every topic in surgery is presented in such a form as to enable the busy practitioner to review any subject in every-day practice in a short time. JNo time is lost with useless theories or superfluous verbiage. In short, the worlv is eminently clear, logical and practical. — Chicago Medical Journal and Examiner, April, 1886. The fourth edition of this work is fully abreast of the times. The author handles his subjects with that degree of judgment and skill which is attained by years of patient toil and varied ex- perience. The present edition is a thorough re- vision of those which preceded it, with much new matter added. His diction is so graceful and logical, and his explanations are so lucid, as to place the work among the highest order of text- By the same Author. Diseases of the Breast. In one 12mo. volume. Preparing. See Series of Clinical Manuals, page 4. TBFVFS, FBEDEBICK, F. JR. C. S., Hunterian Professor at the Royal College of Surgeons of England. A Manual of Surgery. In Treatises by Various Authors. In three 12mo. volumes, containing 1866 pages, with 213 engravings. Price per volume, cloth, $2. See Students' Series of Manuals, page 4. in the choice, arrangement and logical sequence of the subjects. Every topic, as far as observed, is treated with a fulness of essential detail, which is somewhat surprising. Another characteristic of the work is the well-nigh universal acceptance of mod- ern and progressive views of pathology and treat- ment. The entire work is conceived and executed in a scientific spirit. It contains the bone and mar- row of modern surgery.— ^nna^s of Suruerv, Oct. 1886. We have here the opinions of thirty-three authors, in an encyclopsedic form for easy and ready reference. The three volumes embrace every variety of surgical affections likely to be met with, the paragraphs are short and pithy, and the salient points and the beginnings of new sub- jects are always printed in extra-heavy type, so that a person may find whatever information he may be in need of at a moment's glance. — Cin- cinnati Lancet-Clinic, August 21, 1886. The hand of Mr. Treves is evident throughout BTITLIJN, HENBY T., F. B. C. S., Assistant Surgeon to St. Bartholomew's Hospital, London. Diseases of the Tongue. In one 12mo. volume of 456 pages, with 8 colored plates and 3 woodcuts. Cloth, $3.50. See Series of Clinical Manuals, page 4. The language of the text is clear and concise. The author has aimed to state facts rather than to express opinions, and has compressed within the compass of this small volume the pathology, etiol- ogy, etc., of diseases of the tongue that are incon- veniently scattered through general works on sur- gery and the practice of medicine. The physician and surgeon will appreciate its value as an aid and guide. — Physician and Surgeon, Sept. 1886. TBEVES, FBEJDEBICK, F. B. C. S., Surgeon to and Lecturer on Surgery at the London Hospital. Intestinal Obstruction. In one pocket-size 12mo. volume of 522 pages, with 60 illustrations. Limp cloth, blue edges, $2.00 A standard work on a subject that has not been 80 comprehensively treated Dy any contemporary English writer. Its completeness renders a full review difficult, since every chapter deserves mi- nute attention, and it is impossible to do thorough See Series of Clinical Manuals, page 4. justice to the author in a few paragraphs. Intes- tinal Obstruction is a work that will prove of equal value to the practitioner, the student, the pathologist, the physician and the operating sur- geon. — British Medical Journal, Jan. 31, 1885. GOUEJD, A. JPEABCE, JK. S., 31. B., F. B. C. S., Assistant Surgeon to Middlesex Hospital. Elements of Surgical Diagnosis. In one pocket-size 12mo. volume of 589 pages. Cloth, $2.00. See Students' Sei-ies of Manuals, page 4. PIRRIE'S PRINCIPLES AND PRACTICE OF | SKEY'S OPERATIVE SURGERY. In one vol. 8to. SURGERY. Edited by John Neill, M. D. In of 661 pages, with 81 woodcuts. Cloth, 83.25. one 8vo. vol. of 784 pp. with 316 illus. Cloth, 83.75. | 22 Lea Brothers & Co.'s Publications — Surgery, Frac, Disloc. SOLMBS, TIMOTHTTf 31. A,, Surgeon and Lecturer on Surgery at St. George's Hospital, London. A System of Surgery ; Theoretical and Practical. IN TREATISES BY VARIOUS AUTHORS. American edition, thoroughly revised and be-edited by John H. Packard, M. D., Surgeon to the Episcopal and St. Joseph's Hospitals, Philadelphia, assisted by a corps of thirty-three of the most eminent American surgeons. In three large and very handsome imperial octavo volumes containing 3137 double- columned pages, with 979 illustrations on wood and 13 lithographic plates, beautifully colored. Price per set, cloth, $18.00; leather, $21.00; half Russia, $22.50. Sold only by subscription. HAMILTON, FMAJSrK S., M. D., LL, JD,, Surgeon to Bellevue Hospital, New York. A Practical Treatise on Fractures and Dislocations. Seventh edition thoroughly revised and much improved. In one very handsome octavo volume of 998 pages, with 379 illustrations. Cloth, $5.50 ; leather, $6.50 ; very handsome half Russia, opep back, $7.00. ' " ■ " " "^-"^ any lengthened review. We can only say that it is still unapproached as a treatise, and that it is a proof of the zeal and industry ana great ability of its distinguished author. — The Dublin Journal oj Medical Science, Feb. 1886. His famous treatise on Fractures and Dislocor tions, published first in 1860, is justly regarded as the best book on that subject in existence. It has now run through seven editions, and has been translated into French and German. — Medical Record, Aug. 14, 1880. It is about twenty-five years ago since the first edition of this great work appeared. The edition now issued is the seventh, and this fact alone is enough to testify to the excellence of it in all par- ticulars. Books upon special subjects do not usually command extended sale, but this one is without a rival in any language. It is essentially a practical treatise, and it gathers within its covers almost everything valuable that has been written about fractures and dislocations. The principles and methods of treatment are very fully given. The book is so well known that it does not require SMITH, STEPHEN, M. D., Professor of Clinical Surgery in the University of the Cit;/ of New York. The Principles and Practice of Operative Surgery. New (second) and thoroughly revised edition. In one very handsome octavo volume of 892 pages, with 1005 illustrations. Cloth, $4.00; leather, $5.00. Just ready. This work is too well and too favorably known lo 1 plete works in the English language, and is a fit require any words of commendation, and its mer- ! companion to Malgaigne'.s magnificent treatise, its effectually protect it from adverse criticism. The woodcuts are good, and are very numerous. It is a treatise upon the principles as well as the I The descriptions of operative procedures are plain, practice of mechanical surgery. The subject mat- and the opinions expressed are conservative and ter isbroughtdown to the very latest period, hence ' judicious. The work reflects great credit upon the we shall find the work to be a faithful exponent j author and upon American surgical literature. — of the art of surgery as practised now. Stephen ! The American Journal of the Medical Sciences, April, Smith's Operative Surgery is one of the most com- 1 1887. STIMSON, LEWIS A., B. A., M, H,, Professor of Pathological Anatomy at the University of the City of Neio York, Surgeon and Curator to Sellevue Hospital, Surgeon to the Pi-esbyterian Hospital, New York, etc. A Manual of Operative Surgery. New (second) edition. In one very hand- some royal 12mo. volume of 503 pages, with 342 illustrations. Cloth, $2.50. There is always room for a good book, so that while many works on operative surgery must be considered superfluous, that of Dr. Stimson has held its own. The author knows the difficult art of condensation. Thus the manual serves as a work of reference, and at the same time as a handy guide. It teaches what it professes, the steps of operations. In this edition Dr. Stimson has sought to indicate the changes that have been effected in operative methods and procedures by the antiseptic system, and has added an account of many new operations and variations in the steps of older operations. We do not desire to extol this manual above many excellent standard British publications of the same class, still we be- lieve that it contains much that is worthy of imi- tation. — British Medical Journal, Jan. 22, 1887. By the same Author. A Practical Treatise on Fractures. In one very handsome octavo volume ot 598 pages, with 360 beautiful illustrations. Cloth, $4.75 ; leather, $5.75 The author has given to the medical profession in this treatise on fractures what is likely to be- come a standard work on the subject. It is certainly not surpassed by any work written in the English, or, for that matter, any other language. The au- thor tells us in a short, concise and comprehensive manner, all that is known about his subject. There is nothing scanty or superficial about it, as in most other treatises ; on the contrary, everything is thor- ough. The chapters on repair of fractures and their treatment show him not only to be a profound stu- dent, but likewise a practical surgeon and patholo- gist. His mode of treatment of the different fract- ures is eminently sound and practical. We consider this work one of the best on fractures ; and it will be welcomed not only as a text-book, but also by the surgeon in full practice. — N. O. Medical and Surgical Journal, March, 1883. MARSH, HOW Ann, F, It. C. S., Senior Assistant Surgeon to and Lecturer on Anatomy at St. Bartholomew's Hospital, London. Diseases of the Joints. In one 12mo. volume of 468 pages, with 64 woodcuts and a colored plate. Cloth, $2.00. See Series of Clinical Manuals, page 4. PICK, T. PICKERING, F. M. C. S., Surgeon to and Lecturer on Surgery at St. George's Hospital, Lond-on.- Fractures and Dislocations. In one 12mo. volume of 530 pages, with 93 illustrations. Limp cloth, 2.00. See Series of Clinical Manuals, page 4. Lea Brotheks & Co.'s Publications — Otol., Oplitlial. 23 BVMNJETT, CMARLBS H,, A, 31,, M, 1?., Professor of Otology in the Philadelphia Polyclinic ; President of the American Otological Society. The Ear, Its Anatomy, Physiology and Diseases. A Practical Treatise for the use of Medical Students and Practitiouers. New (second) edition. In one handsome octavo vohime of 580 pages, with 107 illustrations. Cloth, $4.00 ; leather, $5.00. We note with pleasure the appearance of a second edition of this vahiafale work. When it first came out it was accepted by the profession as one of the standard works on modern aural surgery in the English language; and in his second edition Dr. Burnett has fully maintained his reputation, for the book is replete with valuable information and suggestions. The revision has been carefully carried out, and much new matter added. Dr, Burnett's work must be regarded as a very valua- ble contribution to aural surgery, not only on account of its comprehensiveness, but because it contains the results of the careful personal observa- tion and experience of this eminent aural surgeon. — London Lancet, Feb. 21, 1885. POJLITZBH, ADAM, Imperial- Royal Prof, oi Aural Therap. in the Univ. of Vienna. A Text-Book of the Ear and its Diseases. Translated, at the Author's re- quest, by James Patterson Cassells, M. D., M. R. C. S. In one handsome octavo vol- ume of 800 pages, with 257 original illustrations. Cloth, $5.50. The work itself we do not hesitate to pronounce the best upon the subject of aural diseases which has ever appeared, systematic without being too diffuse on obsolete subjects, and eminently prac- tical in every sense. The anatomical descriptions of each sep.irate division of the ear are admirable, and profusely illustrated by woodcuts. They are followed immediately by the physiology of the section, and this again by the pathological physi- ology, an arrangement which serves to keep up the interest of the student by showing the direct ap- plication of what has preceded to the study of dis- ease. The whole work can be recommended as a reliable guide to the student, and an efficient aid to the practitioner in his treatment. — Boston Med- ical and Surgical Journal, June 7, 1883. JVLEIt, SENRY JE,, F, JR. C. S., Senior Ass't Surgeon, Boyal Westminster Ophthalmic Hasp. ; late Clinical Ass't, Moorfields, London. A Handbook of Ophthalraic Science and Practice. In one handsome octavo volume of 460 pages, with 125 woodcuts, 27 colored plates, selections from the Test-types of Jaeger and Snellen, and Holmgren's Color-blindness Test. Cloth, $4.50 ; leather, $5.50. This work is distinguished by the great num- ber of colored plates which appear in it for illus- trating various pathological conditions. Thevare very oeautiful in appearance, and have been executed with great care as to accuracy. An ex- amination of the work shows it to be one of high standing, one that will be regarded as an authority among ophthalmologists. The treatment recom- mended is such as tlie author has learned from actual experience to be the best. — Cincinnati Medi- cal News, Dec. 1884. It presents to the student concise descriptions and typical illustrations of all important eye affections, placed in juxtaposition, so as to be f rasped at a glance. Beyond a doubt it is the est illustrated handbook of ophthalmic science which has ever appeared. Then, what is still better, these illustrations are nearly all original. We have examined this entire work with great care, and it represents the commonly accepted views of advanced ophthalmologists. We can most heartily commend this book to all medical stu- dents, practitioners and specialists. — Detroit Lancet, Jan. 1885. JSrORMIS, WM. F,, 31, 1)., and OLIVER, CSAS. A., 3f, 2). Clin. Prof, of Ophthalmology in Univ. of Pa. A Text-Book of Ophthalmology. In one octavo volume of about 500 pages, with illustrations. Preparing. CARTER, R. BRUDEWELL, <& FROST, W, AI)A3IS, F. R. C. S., F. R. C. S., Ophthalmic Surgeon to and Lecturer on Oph- Assistant Ophthalmic Surgeon to and Joint thalmic Surgery at St. George's Hospital, Lecturer on Ophthalmic Surgery at St. London. George's Hospital, London. Ophthalmic Surgery. In one 12mo. volume of about 400 pages. Preparing. See Series of Clinical Manuals, page 4. WELLS, J. SOELBERG, F. R. O. S., Professor of Ophthalmology in Kinq^s College Hospital, London, etc. A Treatise on Diseases of the Eye. New (fifth) American from the third London edition. In one large octavo volume. Preparing. NETTLESSIF, EDWARD, F. R. C, S., Ophthalmic Surg. a7id Led. on Ophth. Surg, at St. Thomas' Hospital, London. The Student's Guide to Diseases of the Eye. New (third) edition, thor- oughly revised. With a chapter on the Detection of Color-Blindness, by William Thomson, M. D., Professor of Ophthalmology in the Jefferson Medical College. In one royal 12mo. volume of about 450 pages, with about 150 illustrations. Cloth, $2. Shorthj. BROWNE, EDGAR A,, Surgeon to the Liverpool Eye and Ear Infirmary and to the Dispensary for Skin Diseases. How to Use the Ophthalmoscope. Being Elementary Instructions in Oph- thalmoscopy, arranged for the use of Students. In one small royal 12mo. volume of 116 pages, with 35 illustrations. Cloth, $1.00. LAURENCE AND MOON'S HANDY BOOK OF OPHTHALMIC SURGERY, for the use of Prac- titioners. Second edition. In one octavo vol- ume of 227 pages, with 65 illust. Cloth, 82.75. LAWSON ON INJURIES TO THE EYE, ORBIT AND EYELIDS: Their Immediate and Remote Effects. 8 vo., 404 pp., 92 illus. Cloth, $3.50. 24 Lea Brothers & Co.'s Publications — Urin. Dis., Dentistry, etc. ROBERTS, WILLIAM, 31. J>., ' Lecturer on Medicine in the Manchester School of Medicine, etc. A Practical Treatise on Urinary and Renal Diseases, including Uri- nary Deposits. Fourth American from the fourth London edition. In one hand- some octavo volume of 609 pages, with 81 illustrations. Cloth, $3. .50. The previous editions of this book liave made it | The peculiar value and finish of the book are in so familiar to and so highly esteemed by the med- i a measure derived from its resolute maintenance ical public, that little more is necessary than a : of a clinical and practical character. It is an un- mere announcement of the appearance of this, ; rivalled exposition of everything which relates their successor. But it is pleasant to be able to : directly or indirectly to the diagnosis, prognosis say that, good as those were, tliis is still better, and treatment of urinary diseases, and possesses in fact, we think it maybe said to be the best book a completeness not found elsewhere in our lan- in print on the subject of which it treats. — The ^ guage in its account of the different affections. — American Journal of the Medical Sciences. — Jan. 1886. [ The Manchester Mf.dical Chronicle, July, 1885. rURDY, CHARLES W., M. D, Bright's Disease and Allied Affections of the Kidneys. In one octavo volume of 288 pages, with illustrations. Cloth, $2. Just ready. The object of this work is to "furnish a system- atic, practical and concise description of the pathology and treatment of the chief organic diseases of the kidney associated with albuminu- ria, which shall represent the most recent ad- vances in our knowledge on these subjects ;" and short space the theories, facts and treatments, and going more fully into their later developments. On treatment the writer is particularly strong, steering clear of generalities, and seldom omit- ting, what text-books usually do, the unimportant items which are all important to the general prae- this definition of the object is a fair description of titioner. — The Manchester Medical Chronicle, Oct., the book. The work is a useful one, giving in a | 1886. MORRIS, HEJSTRY, M. B., F. R. C. S,, Surgeon to and Lecturer on Surgery at Middlesex Hospital, London. Surgical Diseases of the Kidney. In one 12mo. volume of 554 pages, with 40 woodcuts, and 6 colored jilates. Limp cloth, $2.25. See Series of Clinical Manuals, page 4. In this manual we have a distinct addition to he took in hand. It is a full and trustworthy surgical literature, which gives information not book of reference, both for students and prac- elsewhere to be met with in asingle work. Such ticioners in search of guidance. The illustrations a book was distinctly required, and Mr. Morris in the text and the chromo-lithographs are beau- has very diligently and ably performed the task i tifully executed. — The London Lancet, Feb. 2G,18S6. LUCAS, CLEMENT, 31. B., B. S., ¥, R, C. S., Senior Assistant Surgeon to Ouj/'s Hospital, London. Diseases of the Urethra. In one 12mo. volume. Preparing. See Series of Clinical Manuals, l>age 4. THOMPSON, SIR HENRY, Surgeon and Professor of Clinical Surgen/ to f'niversity College Hospital, Ixmdon. Lectures on Diseases of the Urinary Organs. Second American from the third English edition. In one Svo. volume of 203 pp., with 25 illustrations. Cloth, $2.25. By the Same Author. On the Pathology and Treatment of Stricture of the Urethra and Urinary Fistulse. From the third English edition. In one octavo volume of 359 pages, with 47 cuts and 3 plates. Cloth, $3.50. THE A3IERICAN SYSTE3I OF DENTISTRY. In Treatises by Various Authors. Edited by Wilbur F. Litch, M. D., D. D. S., Professor of Prosthetic Dentistry, Materia Medica and Therapeutics in the Pennsylvania College of Dental Surgery. In three very handsome octavo volumes of about 1000 pages each, richly illustrated. Per volume, clotli, $6 ; leather, $7 ; half Morocco, gilt top, $8. Volume I., containing 1015 pages, with 6 plates and 537 woodcuts, just ready. For sale by subscription only. As an encyclopsedia of Dentiftry it has no su- I doubtless it is), to mark an epoch in the history of perior. It should form a part of every dentist's library, as the information it contains is of the freatest value to all engaged in the practice of entistry. — A7nerican Journal of Dental Science, September, 1886. A grand system, big enough and good enough and handsome enough for a monument (which dentistry. Dentists will be satisfied with it and proud of it — they must. It is sure to be precisely what the student needs to put him and keep him in the right track, while the profession at large will receive incalculable benefit from it. — Odonto- graphic Journal, Jan. 1887. COLE3IAN, A., L. R. C. F., F. R. C. S., Exam. L. H. S., Senior Dent. Surg, and Led. on Dent. Surg, at St. Bartholomew's Hosp. and the Dent. Hosp., London. A Manual of Dental Surgery and Pathology. Thoroughly revised and adapted to the use of American Students, by Thomas C. Stellwagen, M. A., M. D,, D. D. S., Prof, of Physiology at the Philadelphia Dental C/ollege. In one handsome octavo volume of 412 pages, with 331 illustrations. Cloth, $3.25. ES3IARCH, Hr. FRIEHRICH, Professor of Surgery at the University of Kiel, etc. Early Aid in Injuries and Accidents. Five Ambulance Lectures. Trans- lated by li. R. H. Princess Christian. In one handsome small 12mo. volume of 109 pages, with 24 illustrations. Cloth, 75 cents. BASHAM ON RENAL DISEASES : A Clinical I one 12mo. vol. of 304 pages, with 21 illustrations, f^uide to their Diagnosis and Treatment. In | Cloth, 82.00. Lea Brothers & Co.'s Publications — Venereal, Impotence. 25 GROSS, SAIJUJ^JO IF., A. M., 31. J)., LL, !>., Professor of the Principles of Surgery and of Clinical Surgery in Ike Jeffernon Medical College of Phila. A Practical Treatise on Impotence, Sterility, and Allied Disorders of the Male Sexual Organs. New (third) edition, thoroughly revised. In one very handsome octavo volume of 163 pages, with 16 illustrations. Cloth, $1.50. Just ready. We must congratulate the author that another i that it has been translated into Russian may indi- edition has been made necessary. The tone of the book is healthy, and a cheerful prognosis is given of many of the affections of which it treats. We feel confident that the book will continue to sell on its merits. — A'. }". Med. Joxirnal, .June 18, 1887. It must be gratifying to both author and pub- lishers that large first and second editions of this little work were so soon exhausted, while the fact cate that it filled a void even in foreign literature. His is a careful and physiological study of the sexual act, so far as concerns the male, and all his conclusions are scientifically reached. The book has a place by itself in our literature, and furnishes a large fund of information concerning important matters that are too often passed over in silence.— r/ze Medical Press, June, 1887. BUMSTEAn, F, J,, and TAYLOR, R. TT., M, JD., LL. n., A. M., M. D., Late Pofessor of Venereal Diseases Surgeon to Charity Hospital, New York, Prof, of at the College of Physicians and Venereal and Skin Diseases »'i the University of Surgeons, Neiv York, etc. Vermont, Pres. of the Am. Dermatological Ass'n. The Pathology and Treatment of Venereal Diseases. Including the results of recent investigations upon the subject. Fifth edition, revised and largely re- written, by Dr. Taylor. In one large and handsome octavo volume of 898 pages with 139 illustrations, and thirteen chromo-lithographic figures. Cloth, $4.75 ; leather, $5.75 ; very handsome half Kussia, $6.25. It is A splendid record of honest labor, wide j known that it would be superfluous here to pass in research, just comparison, careful scrutiny and original experience, which will always be held as a high credit to American medical literature. This is not only the best work in the English language upon the subjects of which it treats, but also one wnich has no equa. in other tongues for its clear, comprehensive and practical handling of its themes. — Am. Jour, of the Med. Sciences, Jan, 1884. It is certainly the best single treatL-ie on vene- real in our own, and probably the be.st in any lan- guage. — Boston Med. and Surg. Journal, April 3, 1884. The character of this standard work is so well review its general or special points of excellence. The verdict of the profession has been passed; it has been accepted as the most thorough and com- plete exposition of the pathology and treatment of venereal diseases in the language. Admirable as a model of clear description, an exponent of sound pathological doctrine, and a guide for rational and successful treatment, it is an ornament to the medi- cal literature of this country. The additions made to the present edition are eminently judicious, from the standpoint of practical utility. — Journal of Cutaneous and Venereal Diseases, Jan. i884. CORJSLL, F., Professor to the Faculty of Medicine of Paris, and Physician to the Lonreine Hospital. Syphilis, its Morbid Anatomy, Diagnosis and Treatment. Specially revised by the Author, and translated with notes and additions by J. Henry C. SlMES, M. D., Demonstrator of Pathological Histology in the University of Pennsylvania, and J. William White, M. D., Lecturer on Venereal Diseases and Demonstrator of Surgery in the University of Pennsylvania. In one handsome octavo volume of 461 pages, with 84 very beautiful illustrations. Cloth, $3.75. The anatomy, the histology, the pathology and : perusal without the feeling that his gra.sp of the the clinical features of syphilis are represented in ' wide and important subject on which it treats is this work in their best, most practical and most a stronger and surer one. — The London Practi- instructive form, and no one will rise from its [ tioner. Jan. 1882. SUTCSIWSOJ\, JOJSATHAJS^, F. R. S., F. R. C. S., Consulting Surgeon to the London Hospital. Syphilis. In one 12mo. volume of 542 pages, with 8 chromo-lithographs. Cloth, $2.25. Just ready. See Series of Clinical. Mnnuab, page 4. • FROM THE PREFACE. In the following pages I have aimed less at systematic completeness than at clinical exposition. To the latter subject I have devoted my best efforts, and my hope is that those who may honor this work by their attentive perusal will obtain from its pages clear impressions on the state of our knowledge on the topics which it concerns. GROSS, S. n., M. 2>., LL. L>., D. C. L., etc. A Practical Treatise on the Diseases, Injuries and Malformations of the Urinary Bladder, the Prostate Gland and the Urethra. Third edition, thoroughly revised by Samuel W. Gross, M. D. In one octavo volume of 574 pages, with 170 illustrations. Cloth, $4.50. CULLERIFR, A., & BUMSTBAD, F. J., M.L>., LL.D., Surgeon to the HOpital du Midi. Late Professor of Venereal Diseases tn the College of Physidant and Surgeons, iVeio York. An Atlas of Venereal Diseases. Translated and edited by Freeman J. BuM- BTEAD, M. D. In one imperial 4to. volume of 328 pages, double-columns, with 26 plates, containing about 150 figures, beautifully colored, many of them the size of life. Strongly bound in cloth, $17.00. A specimen of the plates and text sent by mail, on receipt of 25 cts. HILL ON SYPHILIS AND LOCAL CONTAGIOUS FORMS OF LOCAL DISEASE AFFECTING DISORDERS. In one 8vo vol. of 479 p. Cloth, 83.25. PRINCIPALLY THE ORGANS OF GENERA- LEE'S LECTURES ON SYPHILIS AND SOME 1 TION. In one 8vo. vol. of 246 pages. Cloth, $2 26. 2H Lea Brothers & Co.'s Publications — Diseases of Skin. KAPOSI, MOBIZ, Of Vienna. The Pathology and Treatment of Diseases of the Skin! For the use of Practitioners and Students. Translated, with the author's i^ermission, by W. Xayiek SuDDUTH, M. D., F. E. M. S. In one octavo vohime of about 600 pages, with 74 engrav- ings and 8- colored plates. Preparing. STDJE, J. IfEVINS, A. M., M. 2)., Professor of Dermatology a7id Venereal Diseases in Rush Medical College, Chicago. A Practical Treatise on Diseases of the Skin. For the use of Students aud Practitioners. In one handsome octavo volume of 570 pages, with 66 beautiful aud elab- orate illustrations. Cloth, $4.25 ; leather, $5.25. The author has given the student and practi- tioner a worli admirably adapted to the wants of each. We can heartily commend the book as a valuable addition to our literature and a reliable guide to students and practitioners in their studies and practice. — Am. Joum. of Med. Sci., July, 1883. The aim of the author has been to presenttohis readers a work not only expounding the most modern conceptions of his subject, but presenting what is of standard value. He has more especially devoted its pages to the treatment of disease, and by his detailed descriptions of therapeutic meas- ures has adapted them to the needs of the physi- cian in active practice. In dealing with these questions the author leaves nothing to the pre- sumed knowledge of the reader, but enters tnor- oughly into the most minute description, so that one is not only told what should be done under given conditions but how to do it as well. It is therefore in the best sense " a practical treatise." That it is comprehensive, a glance at the index will show. — Maryland Medical Journal, July 7, 1883. Professor Hyde has long been known as one of the most intelligent and enthusiastic representa- tives of dermatology in the west. His numerous contributions to tne literature of this specialty have gained for him a favorable recognition as a careful, conscientious and original observer. He has attempted, as he informs us, the task of pre- senting in a condensed form the results of the latest observation and experience. A careful ex- amination of the work convinces us that he has accomplished his taslc with painstaking fidelity and with a creditable result. — Journal of Cutaneous and Venereal Diseases, June, 1883. The several diseases are described very con- cisely, but at the same time with unusual clear- ness. The treatment is given in the simplest man- ner and apparently with great honesty. It is a good book, remarkably adapted to the needs of those for whom it was written. It sliould be at once placed in the library of every general practi- tioner. — Detroit Lancet, April, 1883. FOX, T,, 3I.jy.,F.R.C,P,,andFOX,T,C.,B,A.,M.It,C,S,, Physician to the Department for Skin Diseases, Physician for Diseases of the Skin to the University College Hospital, London. West7ninster Hospital, London. An Epitome of Skin Diseases. With Formulae. For Students and Prac- titioners. Third edition, revised and enlarged. In one very handsome 12mo. volume of 238 pages. Cloth, $1.25. The third edition of this convenient handbook <;alls for notice owing to the revision and expansion which it has undergone. The arrangement of skin diseases in alphabetical order, which is the method of classification adopted in this work, becomes a positive advantage to the student. The book is one which we can strongly recommend, not only to students but also to practitioners who require a compendious summary of the present state of dermntolo^y.— British Medical Journal, July 2, 1883. We cordially recommend Fox's Epitome to those •whose time is limited and who wish a handy manual to lie upon the table for instant reference. Its alphabetical arrangement is suited to this use, for all one has to know is the name of the disease, and here are its description and the appropriate treatment at hand and ready for instant applica- tion. The present edition has been very carefully revised and a number of new diseases are de- scribed, while most of the recent additions to dermal therapeutics find mention, and the formu- lary at the end of the book has been considerably augmented. — The Medical News, December, 1883. MORRIS, 3IALCOL3I, F. R. C. S., Joint Lecturer on Dermatology at St. Mary's Hospital Medical School, London. Skin Diseases ; Including their Definitions, Symptoms, Diagnosis, Prognosis, Mor- bid Anatomy and Treatment. A Manual for Students and Practitioners. In one 12mo. volume of 316 pageSj with illustrations. Cloth, $1.75. To physicians who would like to know something about skin diseases, so that when a patient pre- sents himself for relief they can make a correct diagnosis and prescribe a rational treatment, we unhesitatingly recommend this little book of Dr. Morris. The affections of the skin are described in a terse, lucid manner, and their several charac- teristics so plainly set forth that diagnosis will be easy. The treatment in each case is such as the experience of the most eminent dermatologists ad- vises. — Cincinnati Medical News, April, 1880. This is emphatically a learner's book; for we can safely say, that in the whole range of medical literature there is no book of a like scope which for clearness of expression and methodical ar- rangement is better adapted to promote a rational conception of dermatology — a branch confessedly difficult and perplexing to the beginner. — St. Louit Courier of Medicine, April, 1880. The writer has certainly given in a small compass a large amount of well-compiled information, and his little book compares favorably with any other which has emanated from England, while in many points he has emancipated himself from the stub- Dornly adhered to errors of others of his country- men. There is certainly excellent material in the book which will well repay perusal. — Boston Med. and Surg. Joum., March, 1880. WILSON, ERASMUS, F. R. S. The Student's Book of Cutaneous Medicine and Diseases of the Skin. In one handsome small octavo volume of 535 pages.' Cloth, $3.50, HILLIFR, TS03IAS, M, I)., Physician to the Skin Department of University College, London. Handbook of Skin Diseases; for Students and Practitioners. Second Ameri- can edition. In one 12mo. volume of 353 pages, with plates. Cloth, $2,25. Lea Brothers & Co.'s Publications — Dis. of Women. 27 The American Systems of Gynecoloffy and Obstetrics, Systems of Gynecology and Obstetrics, in Treatises by American Authors. Gynecology edited by Matthew D. Mann, A . M., M. D., Professor of Obstetrics and Gynecology in the Medical Department of the University of Buffalo ; and Obstet- rics edited by Barton Cooke Hurst, M. D., Obstefrician to the Philadelphia and to the Maternity Hospitals, Philadelphia. In four very handsome octavo volumes of about 800 pages each, fuUv illustrated by wood engravings and colored plates. Prices per volume: Cloth, §6.00; leather, $7.00; half Kussia, $8.00. Volume I. of the Gynecology, con- taining 784 pages, with 201 engravings on wood and 3 colored plates, is just ready. The subsequent volumes are to follow at regular intervals. For sale by subscription only. Address the Publishers. Full descriptive circular free on application. LIST OF CONTRIBUTORS. WILLIAM H. BAKER, M. D., FORDYCE BARKER, M. I>., LL. D., Edin., ROBERT BATTEY, M. D., SAMUEL C. BUSEY, M. D.. JAMES C. CAMERON, M. D., HENRY C. COE, A. M., M. D., E. C. DUDLEY, A. B., M. D , EDWARD S. DUNSTER, M. D., B. McE. EMMET, M. D., GEORGE J. ENGELMANN, M. D., HAROLD C. ERNST, M. D., HENRY J. GARRIGUES, A. M., M. D., WILLIAM GOODELL, A. M., M. D.. EGBERT H. GRANDIN, A. M., M. D., CHARLES M. GREEN, M. D., SAMUEL W. GROSS, M. D., ROBERT P. HARRIS, M. D., STEPHEN Y. HOWELL, M. D., JAMES B. HUNTER, M. D., A. REEVES JACKSON, A. M., M. D., EDWARD W. JENKS. M. D., LL. D., JOSEPH TABER JOHNSON, M. D., It is exceedingly fitting that a System of Gyne- cology should be given forth as the product of American pens. America is the fountain of mod- ern gynecology, and has contributed more than any other country to its development. All things considered, tlie best treatise on gynecology must be expected from this country, and when the gynecologists of this country unite their efforts in CHARLES CARROLL LEE, M. D., WILLIAM T. LUSK, M. D.,LL. D., MATTHEW D. MANN, A. M., M. D., H. NEWELL MARTIN, F. R. S., M. D., D.Sc,,M.A., RICHARD B. MAURY, M. D., PAUL F. MUNDE, M. D., C. D. PALMER, M. D., ROSWELL PARK, M. D., THEOPHILUS PARVIN, M. D., LL. D., R. A. F. PENROSE, BI. D., LL D., THADDEUS A. REAMY, A. M., M. D., J. C. REEVE, M. D., WILLIAM L. RICHARDSON, M. D., A. D. ROCKWELL, A. M., M. D., ALEXANDER J. C. SKENE, M. D., J. LEWIS SMITH, M. D., R. STANSBURY SUTTON, A. M., M. D., LL. D., T. GAILLARD THOMAS, M. D., LL. D., ELY VAN DE AVARKER, M. D., W. GILL WYLIE, M. D. a "system," the result vrould be disappointing were it not to excel anything of the kind hereto- fore attempted. An examination of the first volume of the work before us justifies every expectation formed of it. We must commend it to every reader interested in the division of medicine of which it treats.— The Medical Age, July 25, 1887. TMOMAS, T. GAILLAItn, M. D., Professor of Diseases of Women in the College of Physicians and Surgeons, N. 7. A Practical Treatise on the Diseases of Women. Fifth edition, thoroughly revised and rewritten. In one large and handsome octavo volume of 810 pages, with 266 illustrations. Cloth, $5.00 ; leather, $6.00 ; very handsome half Kussia, raised bands, $6.50. book additionally interesting and gives it value as a work of reference. — London Medical Times and Gazette, July .30, 1881. That the previous editions of the treatise of Dr. Thomas were thought worthy of translation inta German, French, Italian and Spanish, is enough to give it the stamp of genuine merit. At home it has made its way into the library of every obstet- rician and gynaecologist as a safe guide to practice. No small number of additions have been made to the present edition to make it correspond to re- cent improvements in treatment. — Pacific Medical and Surgical Journal, Jan. 1881. The words which follow " fifth edition" are in this case no mere formal announcement. The alterations and additions which have been made are both numerous and important. The attraction and the permanent character of this book lie in the clearness and truth of the clinical descriptions of diseases; the fertility of the author in thera- peutic resources and the fulness with which the details of treatment are described; the definite character of the teaching; and last, but not least, the evident candor which pervades it. We would also particularize the fulness with which the his- tory of the subject is gone into, which makes the Ems, ABTJBTUR W., 31, D., Zond,, F,jR, C.J*., M,It, C.S,, Assist. Obstetric Physician to Middlesex Hospital, late Physician to British Lying-in Hospital. The Diseases of Women. Including their Pathology, Causation, Symptoms, Diagnosis and Treatment. A Manual for Students and Practitioners. In one handsome octavo volume of 576 pages, with 148 illustrations. Cloth, $3.00 ; leather, $4.00. are among the more common methods of treat- ment, and yet very little is said about them in many of the text-books. The book is one to b© It is a pleasure to read a book so thoroughly good as this one. The special qualities which are conspicuous are thoroughness in covering the whole ground, clearness of description and con- ciseness of statement. Another marked feature of the book is the attention paid to the details of many minor surgical operations and procedures, as, for instance, the use of tents, application of leeches, and use of hot water injections. These warmly recommended especially to students and general practitioners, who need a concise but com- plete resume of the whole subject. Specialists, too, will find many useful hints in its pages.— Boston Med. and Surg. Journ., March 2, 1882. BAMNES, JROBEUT, M, D., E, B. C, JP,, Obstetric Physician to St. Tliomas' Hospital, London, etc. A Clinical Exposition of the Medical and Surgical Diseases of Women. In one handsome octavo volume, with numerous illustrations. New edition. Preparing. WEST, CHABLES, mTId, Lectures on the Diseases of Women. Third American from the third Lon- don edition. In one octavo volume of 543 pages. Cloth, $3.75 ; leather, $4.75. 2B Lea Brothers & Co.'s Publications — Dis. of Women, Midwfy. EMMET, TH03IAS ADDIS, M. D., LL. D., Surgeon to the Woman's Hospital, New York, etc. The Principles and Practice of Gynaecology ; For the use of Students and Practitioners of Medicine. New (third) edition, thoroughly revised. In one large and very handsome octavo volume of 880 pages, with 150 illustrations. Cloth, $5 ; leather, $6; very handsome half Russia, raised bands, $(i.50. We are in doubt whether to congratulate tlie author more than the profession upon the appear- ance of the third edition of this well-known work. Embodying, as it does, the life-long experience of one who has conspicuously distinguished himself as a bold and successful operator, and who lias devoted so much attention to the specialty, we feel sure the profession will not fail to appreciate the privilege thus offered them of perusing the views and practice of the author. His earnestness of purpose and conscientiousness are manifest. He gives not only his individual experience but endeavors to represent the actual state of gynse- cological science and art. — British Medical Jour- nal, May 16, 1885. No jot or tittle of the high praise bestowed upon the first edition is abated. It is still a book of marked personality, one based upon large clinical experience, containing large and valuable ad- ditions to our knowledge, evidently written not only with honesty of purpose, but with a conscien- tious sense of responsibility, and a book that is at once a credit to its author and to American med- ical literature. We repeat that it is a book to be studied, and one that is indispensable to every practitioner giving any attention to gynaecology. — American Journal of the Medical Sciences, April, 1885. The time has pa.ssed when Emmet's Gyncecology was to be regarded as a book for a single country or for a single generation. It has always been his aim to popularize gynaecology, to bring it within easy reach of the general practitioner. The orig- inality of the ideas, aside from the perfect con- fidence which we feel in the author's statements, compels our admiration and respect. We may well take an honest pride m Dr. Emmet's work and feel that his book can hold its own against the criticism of two continents. It represents all that is most earnest and most thouglitlul in American gynaecology. Emmet's work will continue to reflect the individuality, the sterling integrity and the kindly heart of its honored author long after smaller books have been forgotten. — American Journal of Obstetrics, May, 1885. DVNCAJS^, J, MATTHEWS, M.D., LL, D., E, M, S. E., etc. Clinical Lectures on the Diseases of Women ; Delivered in Saint Bar- tholomew's Plospital. In one handsome octavo volume of 175 pages. Cloth, $1.50. They are in every way worthy of their author ; | rule, adequately handled in the text^books; others indeed, we look upon them as among the most | of them, while bearing upon topics that are usually valuable of his contributions. They are all upon | treated of at length in such works, yet bear such a mattersof great interest to the general practitioner. I stamp of individuality that they deserve to be Some of them deal with subjects that are not, as a ! widely read.— iV. Y. Medical Journal, March, 1880. MAY, CHAMLES H,, M. D, Late House Surgeon to Mount Sinai Hospital, New York. A Manual of the Diseases of Women. Being a concise and systematic expo- sition of the theory and practice of gynaecologv. In one 12mo. volume of 342 pages. Cloth, $1.75. Medical students will find this work adapted to tions, and the presentation only of accepted views, their wants. Also practitioners of medicine will it constitutes a very satisfactory exposition of the find it exceedingly convenient to consult for the leading principles "of gynaecology as they are un- purpose of refreshing their minds upon the lead- derstood at the present tim&.— Cincinnati Medical ing points of a gyneeeologieal subject. By syste- News, IS'ov. 1885. tnatic condensation, the omission of disputed ques- HODGE, HVGHL., M. D., Emeritus Professor of Obstetrics, etc., in the University of Pennsylvania. On Diseases Peculiar to Women; Including Displacements of the Uterus. Second edition, revised and enlarged. In one beautifully printed octavo volume of 519 pages, with original illustrations. Cloth, $4.50. By the Same Author. The Principles and Practice of Obstetrics. Illustrated with large litho- graphic plates containing 159 figures from original photographs, and with numerous wood- cuts. In one large quarto volume of 542 double-columned pages. Strongly bound in cloth, $14.00. Specimens of the plates and letter-press will be forwarded to any address, free by mail, on receipt of six cents in postage stamps. MAMSBOTHAM, FRANCIS H., M. D. The Principles and Practice of Obstetric Medicine and Surgery; In reference to the Process of Parturition. A new and enlarged edition, thoroughly revised by the Author. With additions by W. V. Keating, M. D., Proiessor of Obstetrics, etc., in the Jefferson Medical College of Philadelphia. In one large and handsome imperial octavo volume of 640 pages, with 64 full-page plates and 43 woodcuts in the text, contain- ing in all nearly 200 beautiful figures. Strongly bound in leather, with raised bands, $7. WINCKEL, E. A Complete Treatise on the Pathology and Treatment of Childbed, For Students and Practitioners. Translated, with the consent of the Author, from the second German edition, by J. R. Chadwick, M. D. Octavo 484 pages. Cloth, $4.00. ASHWELL'S PRACTICAL TREATISE ON THE DISEASES PECULIAR TO WOMEN. Third American from the third and revised London edition. In one 8vo. vol., pp. 520. Cloth. S3.50. CHURCHILL ON THE PUERPERAL FEVER AND OTHER DISEASES PECULIAR TO WO- MEN. In one 8vo. vol. of 404 pages. Cloth, 82.50. MEIGS ON THE NATURE, SIGNS AND TREAT- MENT OF CHILDBED FEVER. In one 8vo. volume of 346 pages. Cloth, $2.00. Lea Brothers & Co.'s Publications — Midwifery. 29 PARVIJSr, TMBOJPHILVS, 31. D., ii. D., Prof, of Obstetrics and the Diseases of Women and Children m Jefferson Med. Coll., Phila. The Science and Art of Obstetrics. In one handsome 8vo. volume of 697 pages, with 214 engravings and a colored plate. Cloth, $4.25 ; leather, $5.25. It is a ripe harvest that Dr. Parvin offers to his 1 favorable for an agreeable unfolding of the ssience readers. There is no book that can be more .-afely and art of obstetrics. This new book is the easy recommended to the student or that can be turned to in moments of doubt with greater assurance of aid, as it is a liberal digest of .-^afe counsel that has been patiently gathered. — The American Journal of the Medical Sciences, July, 1887. There is not in the language a treatise on the subject which so completely and intelligently gleans the whole field of obstetric literature, giv- uperior of any single work among its predeces- sors for the student or practitioner seeking the best thought of the day in this department of medicine. — The American Practitioner and Neics, April 2, 1887. This treatise maybe defined as exact, concise and scholarly. Parvin's distinguished position as teacher, his scholarly attainments, and his ing the reader the winnowed wheat in concise and I honest endeavor to do his best by both the student well-jointed phrase, in language of exceptional \ and the physician, will secure for his treatise purity and strength. The arrangement of the i favorable recognition. — American Journal of Obstet- matter of this work Is unique and exceedingly | rics. May, 1887. BAItNES, MOBERT, M. !>., and FANCOVMT, 31. J)., Phys. to the General Lying-in Hasp., Lond. Obstetric Phys. to St. Thomas' Hosp., Lond. A System of Obstetric Medicine and Surgery, Theoretical and Clin- ical. For the Student and the Practitioner. The Section on Embryology contributed by Prof. Milnes Marshall. In one handsome octavo volume of 872 pages, with 231 illus- trations. Cloth, $5; leather, $6. This system will be eagerly sought for, not only ; ble teacher and trusted accoucheur, should embody on account of its intrinsic merit, but also because within a single treatise the system which he has the reputation which tlie elder IJarnes, in particu- taught and in practice tested, and which is the out- lar, has secured, carries with it the conviction that , come of a lifetime of earn»st labor, careful obser- any book emanating from him is necessarily sound \ vation and deep study. The result of this arrange- in teaching and conservative in practice. It is in- | ment is the prod nctiono! a work which rises above deed eminently fitting that a man who has done so ; criticism and which in no respect need yield the much towards systematizing the obstetric art, who j palm to any obstetrical treatise hitherto published. for so many years has been widely known as a capa- I — American .Journal of Obstetrics, Feb. 1886. PLATFAIR, W. S., 31. 2>., F. JR. C. F., Professor of Obstetric Medicine in King's College, London, etc. A Treatise on the Science and "Practice of Midwifery. New (fourth) American, from the fifth English edition. Edited, with additions, by Robert P. Har- ris, M. D. In one handsome octavo volume of 654 pages, with 3 plates and 201 engrav- ings. Cloth, $4 ; leather, $5 ; half Russia, $5.50. This still remains a favorite in America, not only because the author is recognized as a safe guide and eminently progressive man, but also as sparing no effort to make each successive edition a faithful mirror of the latest and best practice. A work so frequently noticed as the present requires no further review. We believe that this edition is simply the forerunner of many others, and that the demand will keep pace with the supply. — American Journal of Obstetrics, Nov. 1885. Since its first publication, only eight years ago, it has rapidly become the favorite textrbook, to the practical exclusion of all others. A large measure of its popularity is due to the clear and easy style in which it is written. Few text-books for students have very much to boast of in this respect. — Medical Record. KING, A. F. A., 31. D., Professor of Obstetrics and Diseases of Women m the Medical Department of the Columbian Univer- sity, Washington, D. C., and in the University of Vermont, etc. A Manual of Obstetrics. New (third) edition. In one very handsome 12mo. volume of 376 pages, with 102 illustrations. Cloth, $2.25. This little manual, certainly the best of its kind, fully deserves the popularity which has made a third edition necessary. Clear, practical, concise, its teachings are so fully abreast with recent ad- vances in obstetric science that but few points can be criticised. — American Journal of Obstetrics, March, 1887. This volume deserves commendation. It is not bulky — it is concise. The chapters are divided with sub-headings, which aid materially in the finding of any particular subject, and the definitions are clearand explicit. It fulfils its purpose admirably, and we know of no better work to place in the stu- dent's hands. The illustrations are good. — Arch- ives of Gynecology, January, 1887. BABKFJR, FOBDYCE, A. 31., 31. J)., LL. JO. EcUfi., Clinical Professor of Midwifery and the Diseases of Women in the Bellevue Hospital Medical College, New York, tionorary Fellow of the Obstetrical Societies of London and Edinburgh, etc., etc. Obstetrical and Clinical Essays. In one handsome 12mo. volume of about 300 pages. Preparinrj. BABNES, FAJS^COVBJC, 31. JD., Obstetric Physician to St. Thoma.i' Hospital, London. A Manual of Midwifery for Midwives and Medical Students. In one royal 12mo. volume of 197 pages, with 50 illustrations. Cloth, $1.25. FABBY, JOHN S., 31. !>., Obstetrician to the Philadelphia Hospital, Vice-President of the Obstet. Society of Philadelphia. Extra - Uterine Pregnancy : Its Clinical History, Diagnosis, Prognosis and Treatment. In one handsome octavo volume of 272 pages. Cloth, $2.50. TANNER ON PREGNANCY. Octavo, 490 pages, 4 colored plates, 16 cuts. Cloth, $4.2.5. 30 Lea Brothers & Co.'s Publications — Midwfy., Dis. Cliildn. LBISHMAJ^, WILLIAM, M, 2>., Regius Professor of Midwifery in the University of Olasgow, etc. A System of Midwifery, Including the Diseases of Pregnancy and the Puerperal State. Third American edition, revised by the Author, with additions by John S. Parry, M. D., Obstetrician to the Philadelphia Hospital, etc. In one large and very handsome octavo volume of 740 pages, with 205 illustrations. Cloth, $4.50 ; leather, $5.50 ; very handsome half Russia, raised bands, $6.00 The author is broad in his teachings, and dis- cusses briefly the comparative anatomy of the pel- vis and the mobility of the pelvic articulations. The second chapter is devoted especially to the study of the pelvis, while in the third the female organs of generation are introduced. The structure and development of the ovum are admirably described. Then follow chapters upon the various subjects embraced in the study of mid- wifery. The descriptions throughout the work are plain aiid pleasing. It is sufficient to state that in this, the last edition of this well-known work, every recent advancement in this field has been brought forward. — Physician and Surgeon, Jan. 1880. To the American student the work before us must prove admirably adapted. Complete in all its parts, essentially modern in its teachmgs, and with demonstrations noted for clearness and precision, it will gain in favor and be recognized as a Work of standard merit. The work cannot fail to be popular and is cordially recommended. — N. O. Med. and Surg. Journ., March. 1880. It has been well and carefully written. The views of the author are broad and liberal, and in- dicate a well-balanced judgment and matured mind. We observe no spirit of dogmatism, but the earnest teaching of the thoughtful observer and lover of true science. Take the volume as a whole, and it has few equals. — Maryland Medical Journal, Feb. 1880. LAJSrniS, HENRY G., A. M,, M. J)., Professor of Obstetrics and the Diseases of Women in Starling Medical College, Columbus, O. The Management of Labor, and of the Lying-in Period. In handsome 12mo. volume of 334 pages, with 28 illustrations. Cloth, $1.75. one The author has designed to place in the hands of the young practitioner a book in which he can find necessary information in an instant. As far as we can see, nothing is omitted. The advice is sound, and the proeeedures are safe and practical. Ce.ntralhlatt fiir Gynakologic, December 4, 1886. This is a book we can heartily recommend. The author goes much more practically into the details of the management of labor than most text'books, and is so readable throughout as to tempt any one who should happen to commence the book to read it through. The author pre- supposes a theoretical knowledge of obstetrics, and has consistently excluded from this little work everything that is not of practical use in the lying-in room. We think that if it is as widely read as it deserves, it will do much to improve obstetric practice in general. — New Orleans Medi- cal and Surgical Journal, Mar. 1886. SMITH, J. LJEWIS, M, JD., Clinical Professor of Diseases of Children in the Bellevue Hospital Medical College, N. 7. A Treatise on the Diseases of Infancy" and Childhood. New (sixth) edition, thoroughly revised and rewritten. In one handsome octavo volume of 867 pages, with 40 illustrations. Cloth, $4.50 ; leather, $5.50 ; half Russia, $6.00. Rarely does a pleasanter task fall to the lot of the bibliographer than to announce the appearance of a new edition of a medical classic like Prof. J. Lewis Smith's Treatise on the Diseases of Infancy and Childhood. For years it has stood high in the confidence of the profession, and with the addi- tions and alterations now made it may be said to be the best book in the language on the subject of which it treats. An examination of the text fully sustains the claims made in the preface, that "in preparing the sixth edition the author has revised the text lo such an extent that a considerable part of the book may be considered new." If the young practitioner proposes to place in his library but one book on the diseases of children, we would unhesitatingly say, let that book be the one which is the subject of this notice. — ne American Journal of the Medical Sciences, April, 1886. No better work on children's diseases could be placed in the hands of the student, containing, as it does, a very complete account of the symptoms and pathology of the diseases of early life, and possessing the further advantage, in which it stands alone amongst other works on its subject, of recommending treatment in accordance with the most recent therapeutical views. — British and Foreign Medico-Chirurgical Review. It is a pleasure to the busy practitioner — inter- ested in the advancement of his profession — to meet, fresh from the hands of its author, a medi- cal classic such as Smith on Diseases of Children. Those familiar with former editions of the work will readily recognize the painstaking with which this revision has been made. Many of the articles have been entirely rewritten. The whole work is enriched with a research and reasoning which plainly show that the author has spared neither time nor labor in bringing it^ to its present ap- proach towards perfection. The extended table of contents and the well-prepared index will enable the busy practitioner to reach readily and quickly for reference the various subjects treated of in the body of the work, and even those who are familiar with former editions will find the improvements in the present richly worth the cost of the work. — A tlanta Medical and Surgical Journal, Dec. 1880. OWUJS^, UDMTTJS^I), M, B., F, JR. C. S,, Surgeon to the Children's Hospital, Chreat Ormond St., London. Surgical Diseases of Children. In one 12mo. volume of 525 pages, with 4 cbromo-lithographic plates and 85 woodcuts. Cloth, $2. See Series of Clinical Manuals, page 4. One is immediately struck on reading this book with its agreeable style and the evidence it every- where presents of the practical familiarity of its author with his subject. The book may be honestly recommended to both students and practitioners. It is full of sound information, pleasantly given. — Annals of Surgery, May, 1886. WEST, CHARLES, M. H., Physician to the Hospital for Sick Children, London, etc. On Some Disorders of the Nervous System in Childhood. 12mo. volume of 127 pages. Cloth, $1.00. In one small WEST'S LECTURES ON THE DISEASES OF IN- FANCY AND CHILDHOOD. In one octavo vol. CONDIE'S PRACTICAL TREATISE ON THE DISEASES OF CHILDREN. Sixth edition, re- vised and augmented. In one octavo volume of 779 pages. Cloth, $5.25; leather, 86.25. Lea Brothers & Co.'s Publications — Med. Juris., Mlscel. 31 TIDY, CHAULES MBTMOTT, M. B., F, C, S,, Professor of Chemistry and of Forensic Medicine and Public Health at the London Hospital, etc. Legal Medicine. Volume II. Legitimacy and Paternity, Pregnancy, Abor- tion, Rape, Indecent Exposure, Sodomy, Bestiality, Live Birtli, Infanticide, Asphyxia, Drowning, Hanging, Strangulation, Suffocation. Making a very handsome imperial oc- tavo volume of 529 pages. Cloth, $6.00 ; leather, $7.00. Volume I. Containing 664 imperial octavo pages, witli two beautiful colored plates. Cloth, $6.00 ; leather, $7.00. The satisfaction expressed with the first portion of this work is in no wise lessened by a perusal of the second yolume. We find it characterized by the same fulness of detail and clearness of ex- pression which we had occasion so highly to com- mend in our former notice, and which render it so valuable to the medical jurist. The copious tables of cases appended to each division of the subject must have cost the author a prodigious amount of labor and research, but they constitute one of the most valuable features of the book, especially for reference in medico-legal trials. — American Journal of the Medical Sciences, April, 1884. TAYLOR, ALFBBJ) S., M. D., LecUirer on Medical Jurisprudence aiid Chemistry m Chuy's Hospital, London. A Manual of Medical Jurisprudence. Eighth American from the tenth Lon- don edition, thoroughly revised and rewritten. Edited by John J. Reese, M. D., Professor of Medical Jurisprudence and Toxicology in the University of Pennsylvania. In one large octavo volume of 937 pages, with 70 illustrations. Cloth, $5.00 ; leather, $6.00; half Russia, raised bands, $6.50. The American editions of this standard manual have for a long time laid claim to the attention of the profession in this country; and the eighth comes before us as embodying the latest thoughts and emendations of Dr. Taylor upon the subject to which he devoted his life with an assiduity and success which made him Jacile princeps among English writers on medical Jurisprudence. Both the author and the book have made a mark too deep to be affected by criticism, whether it be censure or praise. In this case, however, we should only have to seek for laudatory terms. — American Journal of the Medical Sciences, Jan. 1881. This celebrated work has been the standard au- thority in its department for thirty-seven years, both in England and America, in both the profes- sions which it concerns, and it is improbable that it will be superseded in many years. The work is simply indispensable to every physician, and nearly so to every liberally-educated lawyer, and we heartily commend the present edition to both pro- fessions. — Albany Law Journal, March 26, 1881. By the Same Author. The Principles and Practice of Medical Jiirisprudence. Third edition. In two handsome octavo volumes, containing 1416 pages, with 188 illustrations. Cloth, $10 ; leather, $12. For years Dr. Taylor was the highest authority in England upon the subject to which he gave especial attention. His experience was vast, his judgment excellent, and his skill beyond cavil. It is therefore well that the work of one who, as Dr. Stevenson says, had an "enormous grasp of all matters connected with the subject," should be brought up to the present day and continued in its authoritative position. To accomplish this re- sult Dr. Stevenson has subjected it to most careful editing, bringing it well up to the times. — Ameri- can Journal of the Medical Sciences, Jan. 1884. By the Same Author. Poisons in Relation to Medical Jurisprudence and Medicine. Third American, from the third and revised English edition. In one large octavo volume of 788 pages. Cloth, $5.50 ; leather, $6.50. JPBJPrJEB, AUGUSTUS J,, M. S,, M. B,, F. B. C. S., Examiner in Forensic Medicine at the University of London. Forensic Medicine. In one pocket-size 12mo. volume. Preparing. See Student^ Series of Manuals, page 4. LFA, SFNBY a Superstition and Force : Essays on The Wager of Law, The Wager of Battle, The Ordeal and Torture. Third revised and enlarged edition. In one handsome royal 12mo. volume of 552 pages. Cloth, $2.50. This valuable work is in reality a history of civ- ilization as interpreted by the progress of jurispru- dence. . . In " Superstition and Force " we have a philosophic survey of the long period intervening between primitive barbarity and civilized enlight- enment. There is not a chapter in the work that should not be most carefully studied ; and however well versed the reader may be in the science of jurisprudence, he will find much in Mr. Lea's vol- ume of which he was previously ignorant. The book is a valuable addition to the literature of so- cial science. — Westminster Revieio, Jan. 1880. By the Same Author. Studies in Church History. The Bise of the Temporal Power- -Ben- eflt of Clergy — Excommunication. octavo volume of 605 pages. Cloth, $2.50. The author is pre-eminently a scholar. He takes up every topic allied with the leading theme, and traces it out to the minutest detail with a wealth of knowledge and impartiality of treatment that compel admiration. The amount of information comjiressed into the book is extraordinary. In no other single volume is the development of the New edition. In one very handsome royal primitive church traced with so much clearness, and with so definite a perception of complex or conflicting sources. The fifty pages on the growth of the papacv, for instance, are admirable for con- ciseness and freedom from prejudice. — Boston Traveller, May 3, 1883. Allen's Anatomy .... American Journal of the Medical Sciences American Systems of Gynecology . American System of Practical Medicine . An American System of Dentistry ♦Ashburst's Surgery .... Ash well on Diseases of Women Attfield's Chemistry .... Ball on the Rectum and Anus Barlcer's Obstetrical and Clinical Essays, Barlow's Practice of Medicine Barnes' Midwifery .... ♦Barnes on Diseases of Women Barnes' System of Obstetric Medicine Bartholow on Electricity Bartholow's New Remedies and their Uses Basham on Renal Diseases . Bell's Comparative Pliysiology and Anatomy Bellamy's Operative Surgery Bellamj''s Surgical Anatomy Blandford on Insanity Bloxam's Chemistry . . . •. *Bristowe's Practice of Medicine . Broadbent on the Pulse Browne on the Ophthalmoscope Bruce's Materia Medica and Therapeutics Brunton's Materia Medica and Therapeutics Bryant on the Breast .... ♦Bryant's Practice of Surgery ♦Bumstead on Venereal Diseases . ♦Burnett on the Ear .... Butlin on the Tongue .... Carpenter on the Use and Abuse of Alcohol ♦Carpenter's Human Physiology . Carter