Handbook of electro-therapeutics

Front matter

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Part I. Physical Introduction

LECTURE I.

The Various Kinds of Currents— Contact Electricity ; the Galvanic Current — Galvanic Circuits— Induction Electricity ; the Faradic Current — The Ordinary Apparatus and Auxiliary Apparatus ; Induction Apparatus and Galvanic Batteries pp. 1-10

LECTURE II.

Accessory Apparatus; Selector or Element Numerator— Polarity Changer — Galvanometer — Measurement of the Absolute Strength of the Current — Rheostat — Con/ ducting Wires — Electrodes and their Various Forms — Electrical Table — Physical and Physiological Recognition of the Poles pp. 11-18

LECTURE III.

Physical Laws of the Diffusion of the Current and their Application in Electro-therapeutics — Ohm's Law — Strength of Current— Resistance of Various Conductors: Resistance of the Animal Tissues, especially the Epidermis — Individual Differences in Man and their Consequences — Essential and Extra-essential Resistance ; Conclusions therefrom Concerning the Construction of Apparatus — Density of the Current and its Laws — Practical Deductions for Various Electro-therapeutical Purposes — Electrolytic and Cataphoric Effects pp. 19-32

Part II. Physiological Introduction

LECTURE IV.

Effects of Electrical Currents on the Healthy Living Body — Electro- physiology of the Motor Nerves and the Muscles — Stimulant Action — PHueger's Law of Contraction — Action of the Poles— Law of Contraction of the Motor Nerves in the Living Body — Polar Method of Examination — Law of Polar Contraction and its

IV CONTENTS.

Different Grades— Faradic and Galvanic Reaction of the Muscles— Electrotonio Phenomena — Electrotonus in the Living Body — Modifying and Exhilarating Effects pp. 83-43

LECTURE V.

Electro-physiology of the Sensory Nerves and Nerves of Special Sense— Sensory Nerves of the Skin and their Law of Contraction— Sensory Nerves of the Muscles — Optic Nerve and Retina — Acoustic Nerve and the Nervous Auditory Apparatus —Nerves of Taste— Nerves of Smell PP- 44-49

LECTURE VI.

Electro-physiology of the Secretory and Vasomotor Nerves — Cervical Sympathetic — Effect of Electrical Currents on the Skin — Electro-physiology of the Brain and Spinal Cord — Phenomena in Galvanization of the Brain and Spinal Cord in Man — Electro-physiology of the Organs of the Thorax and Abdomen — Electrolytic and Cataphoric Effects — Galvanic Introduction of Drugs into the Body — Remak's Catalytic Effects — Indirect Catalyses pp. 50-57

Part III Methods Of Electrical Examination And Elec- Teo-diagnosis

LECTURE VII.

The Methods of Electrical Examination — Examination of the Motor Nerves and Mubcles— Polar Method — General Rules — Method of Quantitative Examination of Irritability with the Faradic and Galvanic Currents — Method of the Qualitative Examination of Irritability — Examination of the Eye — Examination of the Auditory Apparatus — Galvanic Examination of Taste — Examination of Electro-cutaneous Sensibility— Electro-muscular Sensibility pp. 59-08

LECTURE VIII.

Pathological Changes of Electrical Irritability and their Diagnostic Significance — A. Electro-diagnosis of the Motor Nerves and Muscles— 1. Increase— 2. Diminution of Electrical Irritability— 3. Degeneration Reaction— Description of De R— Its Course— Increased Mechanical Irritability pp. 69-78

LECTURE IX.

3. Degeneration Reaction (continued) — Its Relation to Degenerative Atrophy of the Motor Nerves and the Muscles. Their Description — Comparison of their Course with that of the De R — Complete and Partial Degeneration Reaction — Occurrence

of the De R — Diagnostic Conclusions therefrom — Its Prognostic Significance

Special and Critical Remarks , pp. 79-88

Contents

LECTURE X.

4. Rarer Quantitative and Qualitative Changes of Electrical Irritability : a. IncreaBe of Secondary Irritability (Convulsible Reaction)— b. Diminution of Secondary Irritability (Exhaustion Reaction)— e. Qualitative Changes in the Law of Contraction of Motor Nerves— d. Different Reaction of the Nerves to the Faradic and Galvanic Currents — e. Latent Period of Irritation in Faradic Stimulation of the Muscles—/. Diplegic Contractions — B. Electro-diagnosis of the Sensory Nerves — Anomalies of Farado-cutaneous and Farado-muscular Sensibility pp. 89-94

LECTURE XI.

Part IV. General Electro-therapeutics

LECTURE XII.

The Therapeutic Value of Electricity — Various Electro-therapeutic Theories — Empirical Standpoint — Available Effects of the Current and the Method Employed — Stimulating, Modifying (Refreshing), Catalytic Effects — Empirical Basis of the Latter — Direct and Indirect Catalysis — Therapeutic Galvanization of the Cervical Sympathetic — Reflex Effects of the Current pp. 103-112

LECTURE XIII.

Methods of Therapeutic Applications in Local Diseases — Polar or Direction Method ? — Advantages of the Polar Method — Empirical Methods — Influence upon the General Organism: 1. General Faradization (according to Beard and Rockwell) ; 2. General Galvanization ; 3. Central Galvanization (Beard) : 4. The Electrical Bath — Special Methods of Treatment : 1. Galvanic Treatment of Pressure and Painful Points; 2. Treatment with Feeble, Continuous, Galvanic Currents. . pp. 113-120

LECTURE XIV.

General Principles and Special Technical Recommendations for Electrical Treatment — Treatment in Loco Morbi — Technique of the Localization of the Current — Local Faradization of the Motor Nerves and the Muscles — Plan of Treatment- Personal Acquaintance with the Effects of the Current— Choice of the Strength of the Current — Choice and Management of the Electrodes — Avoidance of Unnecessary Irritative Effects — Duration and Frequency of the Individual Applications — Entire Duration of Treatment pp. 121-134

VI CONTENTS.

Part V. Special Electro-therapeutics

Introduction PP- 135-136

T. DISEASES OF THE BKAIN, INCLUDING THE PSYCHOSES.

LECTURE XV.

Introductory Remarks— Physiological, Experimental, and Theoretical Basis of Electrotherapeutics of the Brain — Therapeutical Facts — Collection of a Series of Individual Observations — Conclusions therefrom — Negative or Partial Curative Effects — The Forms of Disease in which Electro-therapeutic Success may, and those in which it may not, be expected pp. 137-147

LECTURE XVI.

Development of Electro-therapeutical Methods — Direct Treatment of the Brain : Catalytic and Vasomotor Effects and the Methods of Producing them — Stimulating and Modifying Effects — Technique of the Application of the Galvanic and Faradic Current in Cerebral Diseases — Indirect Treatment of the Brain : Galvanization of the Sympathetic— Reflex Effects from the Skin — Symptomatic Treatment — Electro-diagnosis in Cerebral Diseases — Electro-therapeutics of Individual Forms of Disease : Cerebral Neurasthenia ; Insomnia ; Hyperemia ; Anosmia ; Hemorrhage ; Cerebral Softening ; Inflammation ; Degeneration ; Sclerosis, etc. ; Bulbar Diseases — Incurable Cerebral Affections pp. 148-155

Appendix

ELECTKO-THEEAPEUTICS OF THE PSYCHOSES.

LECTURE XVII.

Introduction— Investigations of Arndt and their Results— Short Resume of the Literature—Available Effects of the Electrical Current — Rules and Methods of Electrical Treatment of Individual Forms of Psychoses — Treatment of Individual Symptoms pp 156-159

n. DISEASES OF THE SPINAL COED.

LECTURE XVIII.

Introduction— Physiological and Theoretical Basis for the Electro-therapeutics of the

Spinal Cord — Therapeutical Data; Selected Cases— Conclusions therefrom

Therapeutic Failures — Forms of Spinal Disease in which Electro-therapeutic Success may be expected— Methods and Technique of Electro-therapeutics of the Spinal Cord— Direct Treatment : Action of the Poles and the Direction of the

CONTENTS. Vll

Current — Methods of Application in Circumscribed and Longitudinal Diseases — Indirect Treatment : From the Sympathetic ; Combined Treatment of the Sympathetic — Reflex from the Integument — Diplegio Irritation — Treatment of Points of Pressure and Points Douloureux — Symptomatic Treatment pp. 160-109

LECTURE XIX.

Treatment of Individual Forms of Spinal Disease — Electro-diagnostic Preliminary Remarks — 1. Spinal Meningitis — 2. Meningeal Apoplexy— 3. Functional Diseases of the Cord ; Concussion, Spinal Irritation, Spinal Neurasthenia — 4. Hemorrhages into the Spinal Cord : Severe Traumatic Lesions — 5. Myelitis ; Multiple Sclerosis — 6. Tabes Dorsalis ; Direct Galvanic Treatment ; Treatment of the Painful Points ; Farado-cutaneous Brush — 7. Spastic Spinal Paralysis — 8. Acute Anterior Poliomyelitis ; Electrical Examination; Electrical Methods of Treatment— 9. Subacute and Chronic Anterior Poliomyelitis — 10. Progressive Muscular Atrophy ; Condition of the Electrical Irritability ; " Juvenile " Form ; Method of Treatment; Amyotrophic Lateral Sclerosis — 11. Acute Ascending Paralysis — 12. Secondary Degeneration. pp. 170-179

HI. DISEASES OF THE PERIPHERAL NERVES.

LECTURE XX.

Introduction— Available Current Effects in Diseases of the Peripheral Nerves — Practical Experience : Cases — Technique and Methods of Electrical Treatment — Individual Forms of Disease: Neuritis; Hemorrhages and Circulatory Disorders; Slight Mechanical and Traumatic Lesions; Severe Traumatid Lesions; Degenerative Atrophy of the Nerves ; Functional Disorders — Symptomatic Treatment — Electro-diagnostic Remarks pp. 180-186

IV. PARALYSIS AND ATROPHY.

LECTURE XXI.

Definition and Pathogenesis of Paralysis — Objects of Electro-therapeutics in Paralysis and the Methods of Effecting them: a. Removal of the Cause of Paralysis — b. Removal of Obstructions to Motor Conduction ; Direct and Indirect Method ; Utilization of Reflex Paths ; Method of Application of the Faradic and Galvanic Currents for these Purposes — c. Relief of Finer or Grosser Nutritive Disturbances in the Motor Conducting Paths — d. Restoration of the Normal Condition of the Paralyzed Muscles— Treatment of Muscular Atrophy— Results of Electro-therapeutics in Paralysis — Electro-diagnosis of Paralyses — Practical Technical Remarks pp. 187-195

LECTURE XXII.

Electro-therapeutics of Individual Forms of Paralysis— 1. Paralysis of the Ocular Muscles : Pathogenesis ; Cases ; Methods of Treatment ; Results — 2. Paralysis of the Muscles of Mastication — 3. Paralysis of the Facial Nerve : Rheumatic

Vlll CONTENTS.

Form ; its Situation and Nature ; Condition of Electrical Excitability ; Prognosis ; Cases ; Methods of Treatment ; Results— Other Forms of Facial Paralysis — 4. Paralysis of the Spinal Accessory Nerve — 5. Paralysis of the Hypoglossal Nerve pp. 196-205

LECTURE XXIII.

Electro-therapeutics of Individual Forms of Paralysis (continued) — 6. Paralyses of the Neck and Trunk : Pathogenesis ; Cases ; Methods of Treatment — 7. Paralyses of the Upper Limbs: Pathogenesis; Symptomatology; Electro-diagnosis; Cases; Methods of Treatment; Results— 8. Paralyses of the Lower Limbs: Pathogenesis and Individual Varieties ; Electro-diagnosis ; Cases ; Methods of Treatment ; Results pp. 206-218

LECTURE XXIV.

Electro-therapeutics of Individual Forms of Paralysis (conclusion) — 9. Paralysis of the Velum Palati and Pharynx ; Paralysis of Deglutition : Pathogenesis ; Cases ; Methods of Treatment — 10. Paralysis of the Laryngeal Muscles ; Paralysis of the Vocal Cords : Character and Methods of Treatment ; Percutaneous and Endo- Laryngeal Application ; Results — 11. Paralysis of Respiration ; Artificial Respiration; Rhythmical Faradization of the Phrenics — 12. Diphtheritic Paralysis: Pathogenesis and Symptoms ; Cases ; Electrical Treatment ; Galvanization of the Heart; Results — 13. Lead Palsy and other Toxic Paralyses: Characteristics of Lead Palsy ; Electrical Excitability ; Situation and Character of the Disorder ; Method of Treatment — 14. Muscular Atrophy and Hypertrophy : Purely Muscular Atrophy ; Atrophy in Articular Affections ; Cases ; Treatment ; Muscular Hypertrophy ; Congenital Myotonia pp. 219-233

V. PAIN, NEUKALGIA AND NEUKALGIFOKM AFFECTIONS.

LECTURE XXV.

Introduction— Definition and Nature of Pain and Neuralgia— The Neuralgic Change— Electro-therapeutic Objects: Removal of the Abnormal Nutritive Conditions in the Nerves and of the Causes of the Neuralgic Change ; the Actions of the Current Available for this Purpose ; Cases— Electro-therapeutic Methods ; Causal Treatment — Anti-neuralgic Methods : Direct Application of the Galvanic and the Faradic Current ; Indirect, Electro-cutaneous Brush ; Galvanic Treatment of Painful Points— General Plan of Treatment— Results pp. 234-244

LECTURE XXVI.

Individual Forms of Neuralgia : 1. Trigeminal Neuralgia ; Practical Remarks Concerning the Individual Methods of Treatment— 2. Cervico-occipital Neuralgia— 3. Headache and Migraine ; Various Methods of their Treatment — 4. Cervieo-brachial Neuralgia— 5. Intercostal Neuralgia— 6. Neuralgia of the Lumbar Plexus— 7. Sciatica ; Various Methods of Galvanic and Faradic Treatment ; Neuralgia of the Urinary and Sexual Organs ; Coccygodynia— 8. Neuralgias of the Joints— 9. Visceral Neuralgias : Neuralgia of the Pharynx and Larynx ; Angina Pectoris ; Gastralgia ; Enteralgia ; Lead Colic ; Neuralgia in the Distribution of the Pelvic Nerves pp. 245-258

CONTENTS. IX

VI. SPASM AND CONTRACTURE.

LECTURE XXVII.

Introduction : Character and Pathogenesis of Spasms ; the Spastic Change — The Electrical Irritability— Electro-therapeutic Objects: Relief of the Direct Motor Irritation ; Removal of Reflex Stimuli ; Production of Vigorous Inhibition ; Cases — Electro-therapeutic Methods ; Causal Treatment ; Direco Antispastic Treatment and its Methods ; Galvanic and Faradic ; General Plan of Treatment ; Results — Individual Forms of Spasm : Spasms of the Muscles of Mastication ; Mimic Facial Spasm ; Blepharospasm ; Spasm in the Distribution of the Spinal Accessory and in the Neck ; Spasm in the Muscles of the Trunk ; Respiratory Spasm, Singultus, etc. ; Spasms in the Upper and Lower Limba pp. 259-272

VTI. ANESTHESIA.

LECTURE XXVIII.

Character and Pathogenesis of Anaesthesia — Electrical Examination — Objects of Electro-therapeutics ; Cases — Methods of Electrical Treatment : Causal Treatment ; Direct Treatment of Anaesthesia ; Methods with the Faradic and Galvanic Currents ; Relief of Secondary Trophic Disturbances ; Results — Individual Forms : Anaesthesia of the Trigeminus, the Pharynx and Larynx; Vasomotor Anaesthesia ; Hysterical Anaesthesia ; Ataxic Anaesthesia pp. 273-279

VTIL DISEASES OF THE CERVICAL SYMPATHETIC— VASOMOTOR, TROPHIC, AND ALLIED NEUROSES.

LECTURE XXIX

Diseases of the Cervical Sympathetic ; Occurrence and Symptoms ; Irritation and Paralysis ; Methods of Electrical Treatment — Vasomotor Neuroses — Cutaneous Angioneuroses — Symptoms of Spasm and Paralysis of the Vasomotor Neuroses ; Methods of Electrical Treatment — Intermittent Dropsy of the Joints — Vasomotor Trophic Neuroses of the Integument — Anomalies of the Secretion of Perspiration — Progressive Facial Hemiatrophy ; Probable Site ; Methods of Electrical Treatment — Scleroderma ; Method of Treatment pp. 280-287

IX. GENERAL NEUROSES.— CENTRAL AND OTHER FUNCTIONAL

NEUROSES.

LECTURE XXX.

Theory of the Functional Neuroses — Electro-therapeutic Objects : Removal of the Local Nutritive Disturbances ; Influence upon the Entire Nervous System and the Entire Organism ; Removal of Definite Causes of Disease ; Treatment of Individual Symptoms — 1. Neurasthenia: Various Forms; Nature of the Disease ; Methods x CONTEXTS.

of Treatment ; Results— 2. Hypochondriasis— 3. Hysteria ; its Nature, Object, and Methods of Electrical Treatment— 4. Epilepsy— 5. Co-ordinate Professional Hvperkineses ■ Writer's Spasm ; Various Forms ; Methods of Treatment— (3. Chorea Magna. pp. 388-297

LECTURE XXXI.

7. Chorea Minor : Its Situation and Character ; Electrical Treatment— 8. Tetanus : Methods of Treatment— 9. Tetany : Its Characteristics : Electrical Excitability ; Character and Location of the Disease; Electrical Treatment— 10. Catalepsy— 11. Tremor — 12. Paralysis Agitans — 13. Athetosis— 14. Basedow's Disease: Symptoms and Location of the Disease ; Methods of Electrical Treatment— 15. Vertigo— Hi. Diabetes Mellitus and Insipidus pp. 298-305

X. DISEASES OF THE ORGANS OF SPECIAL SENSE.

LECTURE XXXII.

Introduction— Diseases of the Visual Apparatus : Their Electro-diagnosis— Diseases of the Lids, Conjunctiva, Cornea, Iris, Lens, Vitreous Body, Choroid — Diseases of the Retina and Optic Nerve : Retinitis Pigmentosa ; Papillitis and Papillo-retinitis ; Optic Neuritis ; Cases ; Method of Treatment — Atrophy of the Optic Nerve : Tabetic and Genuine Atrophy ; Cases ; Treatment — Amaurosis without Anatomical Lesion — Hemianopsia — Diseases of the Ocular Muscles : Insufficiency of the Interni ; Accommodative Asthenopia ; Mydriasis ; Nystagmus pp. 306-315

LECTURE XXXIII.

Diseases of the Auditory Apparatus — Introduction — Dryness of the Auditory Canal — Opacities of the Membrane — Diseases of the Auditory Nervous Apparatus : Nervous Tinnitus Aurium ; Its Relations to Galvanic Reaction ; Electro-diagnosis; Therapeutic Indications; Determination of the Method of Treatment; Cases; Principles of Treatment ; Special Procedures in Individual Cases ; General Rules and Technical Remarks ; Results — Nervous Deafness ; Cases ; Method of Treatment — Deaf-mutism — Meniere's Disease — Neuroses of the Gustatory Nerves ; Ageusis — Neuroses of the Olfactory Nerves : Anosmia and its Treatment . . . pp. 316-326

XI. DISEASES OF THE ORGANS OF LOCOMOTION, THE GLANDS, THE THORACIC VISCERA, AND THE DIGESTIVE APPARATUS.

LECTURE XXXIV.

Diseases of the Organs of Locomotion : Muscular Rheumatism ; its Varieties and Character ; Various Methods of Treatment ; Results— Articular Affections ; Introduction — Acute Inflammations of the Joints: Traumatic and Other Forms; Rheumatic Polyarthritis ; Chronic Inflammations of the Joints ; 1. Monoarticular Chronic Articular Rheumatism ; 2. Polyarticular Chronic Articular Rheumatism ; 3. Arthritis Deformans; 4. Stiffness and Ankylosis of the Joints— Diseases of the Glandular Organs ; Tumors of the Lymphatic Glands— Scrofula- Splenic Tumors— Diseases of the Thoracic Viscera— Nervous Asthma— Nervous Palpitation of the Heart— Dehility and Irregularity of the Heart. ... pp. 327-335

CONTENTS. XI

LECTURE XXXV.

Diseases of the Digestive Organs : Neuroses of the Oesophagus — Diseases of the Stomach : Nervous Vomiting ; Cardialgia ; Nervous Dyspepsia ; Methods of Electrical Treatment ; Atony and Dilatation of the Stomach — Diseases of the Intestines : Nervous Enteropathy; Enteralgia; Atony and Paralysis of the Muscular Coat of the Intestines : 1. Occlusion of the Intestines by Atonic Accumulation of Faeces ; Pathology ; Cases ; Methods of Electrical Treatment ; Invagination of the Intestines ; 2. Chronic Constipation from Atony of the Intestines ; Cases ; Percutaneous Faradization ; Recto-abdominal Faradization ; Galvano-faradization ; 3. Prolapsus Ani ; Paresis of the Sphincter Ani ; Ascites ; its Faradic Treatment pp. 336-344

XII. DISEASES OF THE URINARY AND SEXUAL ORGANS.

LECTURE XXXVI.

Diseases of the Bladder. Introduction. Vesical Spasm ; Causal and Direct Treatment — Paralysis of the Bladder : Various Forms ; Pathogenesis ; Causal and Direct Treatment ; Percutaneous and Internal Applications ; Galvanization of the Lumbar Cord — Nocturnal Enuresis : Its Nature ; Methods of Treatment — Diseases of the Male Sexual Organs : Inflammation and Hypertrophy of the Prostate ; Orchitis— Functional Disorders: Impotence; Pollutions; Spermatorrhoea ; Aspermatism ; Pathogenesis ; Causal and Direct Treatment — Diseases of the Female Sexual Organs — Introduction — Ovarian Hyperesthesia — Disturbances of Menstruation : Amenorrhoea ; Dysmenorrhoea ; Menorrhagia — Chronic Metritis — Changes in the Position of the Uterus — Deficient Secretion of Milk — Concluding Remarks — Contraindications to the Employment of Electricity — Condition of the Circulatory Organs and Mode of Reaction of the Nervous System pp. 345-357

EXPLANATION OF THE ABBREVIATIONS USED IN THE TEXT.

An = Anode, positive pole.

Ca = Cathode, negative pole.

CI = Closure.

O = Opening.

D= Duration, the j>eriod during which the circuit is closed.

C = Contraction.

Ca CI C = Cathodal closure contraction.

An O C = Anodal opening contraction.

Ca CI Te = Cathodal closure tetanus = Ca D C >, cathodal duration

contraction.

CE= Resistance to conduction.

D N = Deflection of the needle.

De R = Degeneration reaction.

ELECTRO-THERAPEUTICS.

Part I. Physical Introduction

LECTUKE I.

The Various Kinds of Currents — Contact Electrioity ; the Galvanic Current — Galvanic Circuits — Induction Electricity ; the Faradic Current — The Ordinary Apparatus and Auxiliary Apparatus ; Induction Apparatus and Galvanic Batteries.

I mat assume without a doubt that you are acquainted with the doctrine of the physics of electricity in all its main features. This, at all events, forms the only reliable foundation of electro-therapeutics, the basis for an assured employment of this therapeutic agent for diagnostic as well as therapeutic purposes. I cannot, therefore, recommend too strongly to you a careful attention to this subject and its frequent recapitulation. If you desire to become good electro-therapeutists, you must completely master it, so far as it comes in question for our especial purposes. The attainment of this goal will be rendered considerably easier for you by the excellent little works of J. Rosenthal, Fick, Zech, v. Beetz, and de Watteville.

At the same time I neither can nor will omit to give a short descrij)- tion of those features which are absolutely necessary in order to understand what is to come hereafter ; but this can be nothing more than a rapid sketch, which you should fill in by independent study.

As is well known, electricity appears in various modifications, which are dependent on the method of their production and on the arrangement of the current-producing apparatus.

At the present time, we employ almost exclusively, for therapeutic purposes, the so-called electrical current. For a long time past, and even to-day, numerous therapeutic trials have been made with frictional electricity, the so-called tension or static electricity, obtained from frictional electric machines and the so-called induction machines ; but these experiments — even the latest ones made in Paris— have furnished no very encouraging results, and static electricity has still to conquer a secure place in electro-therapeutics. In the following disquisition we shall therefore not refer to this form of electricity — for which, however, the same laws, in general, hold good as for the electrical current.

Electrical currents, as is well known, may be produced by very different substances ; in electro-therapeutics we employ almost exclusively, at the present time : 1, galvanic currents produced by contact (constant, continuous battery currents) ; and 2, the so-called faradic currents produced by induction (induced, interrupted, induction currents). The currents produced by the newer, powerful electrical machines, which are used chiefly for industrial purposes, and which are, perhaps, destined to play a

Si mm fit.

Fig. 1.

Fig. 2.

Fio. 1.— A simple Ralvanic clement ; zinc (Zf) and carbon or copper, (Cu) immersed in a fluid (solution of acid or salts).

Fig. 2.— A simple palvanic element, closed by the circuit of closure (a) ; the direction of the positive current is indicated by the arrow.

prominent part in electro-therapeutics, may be left unnoticed for the present.

Contact Electricity. — The most simple scheme for the production of contact currents — entirely apart from the still unsettled physical theory of galvanism, concerning which we need not enter here further in detailis the following : If two different metals (either copper and zinc, or carbon and zinc) in the shape of plates are placed parallel to one another, but without coming in contact, in a fluid, a solution of a salt or acid (as in Fig. 1), a separation of the electricity in the metals will be produced by their ' contact with the fluid, so that all the positive electricity accumulates, under a certain tension, on the one metal, all the negative electricity on the other.

This tension varies greatly, according to the quality of the metals and the fluid employed. The various metals can be arranged in a series (tension series), in which the one situated at one end becomes most positively electrical from contact with a certain fluid, that at the other end most intensely negatively electrical.

Such a simple combination — two metals in a fluid — is called an open chain, or an open, simple element. If the free ends of the metals are connected with one another by a conducting body, as a metal wire (Fig. 2), the electrical tensions produced upon the two metals are equalized through this wire, which is termed the "circuit of closure," inasmuch as the electricity flows from one metal to the other. We then have a closed element in which an electrical current is flowing.

The equalization of the tension does not cease with the closure of the chain, but the contact of the metals with the fluid (or their chemical action upon one another) causes a continuance of the separation of the electricity, a constantly recurring tension, by means of which — so long as

Fig. 3 — A compound chain. Three elements arranged " behind one another.'' The direction of the current is indicated by the arrows.

metals and fluid are still present — a constant flow of electricity is produced in the circuit of closure and throughout the entire chain.

This power of permanently maintaining and constantly reproducing a certain difference in the electrical tension, is called the electro-motor power of such a combination. Its amount depends alone upon the quality of the metals and fluids employed in the combination. In any individual case, the greater the difference of tension between the two metals, the greater is the amount of electricity produced by the combination, and thus, also, ceteris paribus, the greater will be the strength of the current produced.

If a number of these simple elements are placed alongside one another, and the metal of one connected with the differently named metal of the next (Fig. 3), the tensions produced in all the individual elements will be aggregated, and the sum of these tensions will appear at the terminal points of such a compound chain. It produces a corresponding increase

ELECTRO-THERAPEUTICS.

of the strength of the current in the "circuit of closure,'' which connects the free end of the metal of the last element, which has become positive, with that of the first element, which has become negative.

This form of connection of the elements is called an arrangement "behind one another." In the electro-therapeutics of internal diseases, we make exclusive use of such elements arranged " behind one another " (for reasons which will be made evident later), and these may be collected, in any number desired into so-called "batteries;" we shall therefore, once for all, discuss such elements and batteries alone.

In a compound element of this character, the "circuit of closure" passes from the first to the last element ; the current flowing in it has a

definite strength and direction, and naturally runs in an opposite direction in the element itself from that in the " circuit of closure " — in the " circuit of closure " from the carbon to the zinc, within the chain itself from the zinc to the carbon.

It has been agreed to call that end of the element from which the positive current passes into the "circuit of closure," the positive pole or the anode, the op230site end, where the positive current again enters the chain, i.e., leaves the "circuit of closure," the negative pole, or cathode.

You may now divide the " circuit of closure" — imagined, in its simplest form, as a simple conducting wire — and insert any other conducting body between the two ends (a, Fig. 4). The current will then pass through this conducting body, ac cording to the laws which govern the latter. This is also true when the human body or individual parts of it are inserted in such a " circuit of closure." The points of entrance and exit of the current and its diffusion in the body then depend upon the situations at which both halves of the "circuit of closure " are applied, upon the resistance of the body, etc. These factors all depend upon laws which I shall soon explain to you. That portion of the " circuit of closure " which conveys the positive current to the human body is called the positive pole or anode (An) ; the other part, by which the positive current escapes from the body, the negative pole or cathode (Ca). The portions of the " circuit of closure " giving ingress and egress to the current, and which, for practical purposes, may

Fir,. 4.— Schematic representation of the introduction of the human body (a) into the circuit of closure of a galvanic chain, -j- is the anode, — the cathode.

PHYSICAL INTRODUCTION.

be given various forms at the points of contact with the human body, are called electrodes.

The essence of electro-therapeutics consists simply in the fact that the human body — either as a whole, or generally only certain parts of it — is introduced in a definite manner into the " circuit of closure " of a galvanic (or some other electrical) current ; in other words, the current is conveyed by means of the electrode to the body or its parts, and allowed to act upon it, with a certain intensity, for a variable period, with or without interruptions. It is very evident that an endless variety of applications may be produced in this manner, and that the art of the electro-therapeutist consists essentially in the choice of the proper method of apjDlication in an individual case of disease.

The chief requisite of all galvanic elements employed for electro-therapeutic purposes is that they should furnish a constant current of a strength corresponding to the relations of the human body as regards conduction, and which may be readily conveyed to the body by suitable electrodes. At a later period I will briefly refer to the other necessary auxiliary apparatus.

Induction Electricity. — Under this term we may discuss the induction currents produced by magnets as well as by galvanic currents, since essentially they amount to the same thing.

Electrical currents may be produced by the action of magnets upon closed conductors ; if a magnet is rapidly approximated to such a closed conductor — for exanrple, a wire wound upon a cylinder, a wire spiral, the ends of which are connected with one another — an electrical current develops in the spiral during this approximation : if the magnet is rapidly removed, a current again develops in the spiral, but in the opposite direction from the first. These currents are so much stronger, the stronger the magnet, the more rapid its approximation and removal, and the greater the number of turns in the wire spiral. If the human body is introduced between both ends of the wire spiral, these currents will pass through the body and may thus be employed physiologically and therapeutically. Upon this principle dej>ends the construction of the so-called magneto-electrical or rotation apparatus, in which, by a suitable arrangement, a magnet is very rapidly and frequently approximated and removed from a wire spiral, by means of which a large series of rapidly following currents develop, directed alternately in opposite directions ; these may exercise a very vigorous effect upon the human body. The rotatory apparatus have recently been displaced by the so-called induction apparatus, because their employment was attended with much inconvenience. I will therefore spare you further details concerning their construction.

Perfectly analogous electrical currents may be produced with great readiness by galvanic currents, by means of induction. If a wire spiral, through which a galvanic current is following, is rapidly approximated to

G ELECTRO-THERAPEUTICS.

a similar closed wire spiral, an electrical current develops in the latter during this approximation, and is directed in the opposite direction to that flowing through the former ; if the first spiral is now removed with equal rapidity, a cuia-ent again develops in the second spiral, which now flows in the same direction as that in the first. This is also the case when both spirals are fixed at a certain distance from one another ; and if a galvanic current now develops in the first— the primary— spiral, it is as if it were very rapidly brought from an infinite distance into close proximity, and an induced current will develop accordingly in the other — the secondary — spiral, and likewise when the galvanic current again disappears in the primary spiral. Such a rapid development and disappearance of the current can be produced readily by alternate opening and closure of the primary current in the primary spiral. At each closure, a current develops in the secondary spiral in a direction opposite to the primary current ; at each opening a current develops in the same direction. These "induced " currents are so much stronger, the stronger the primary current, the greater the number of turns in the primary as well as the secondary spirals, and the closer both spirals are to one another — strongest, therefore, when one is pushed entirely over the other.