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Contents
rACB
Introduction. — Importance of Fundamental Principles in the Application of Electricity to the Nose, Throat and Ear — Lack of Scientific Detail in the Majority of Reported Cases — Usefulness of Statistical Information — Necessity of Personal Experience in the Application of Electro-Therapeutics 1-5
Chapter I
Oeneral PRiNaPLES. — Interchangeability of Light, Heat and Electric Energy — Identity of Light and Electro-Magnetic Waves — Frictional. Chemical, Induced and Dynamic Electricity, the Same Form of Energy — Electro- Therapeutics Proper, and Application of the Thermic and Motor Effects of Electricity — Volt, Ampere and Other Units of Electric Energy — Direct, Indirect and Polar Method of Applying Electricity — Electric Test — Dosage — Electric Resistance — Central Galvanization and General Faradization — Static Electricity 6-13
Chapter II
The Various Means of Generating the Galvanic Current. — Animal Electricity — Efficacy of Chemical Cells — Various Chemical Cells and their Relative Value — Storage Battery — Thermo-Electric Battery — Dynamos — Incandescent- Light Current — Volt Selector and Shunt . . I4''33
Chapter VI
Illumination. — Incandescent Lamps — Portable Lamps — Electric Arc Lamp — Enclosed Arc Lamp— Photo-Laryngoscope — Schutt and X-Ray Lamps — Methods of Generating the Incandescent Light — Lamp Resistance, Rheostats, Transformers — Lamps Connected in Series, in Multiple Arc — Forehead Electric Illuminators — Therapeutic Effects of Electric Light — Heating Effects — Incandescent Lamps in Theaters 62-79
Chapter VII
Examination of thb Throat, Nose, Ear and CEsophagus. — Portable Electric Lights — Electric Illuminators — Pan-Electroscope — Combined Mirror and Electric Lamp — Glass Prism for Upright Laryngeal Images — Inspection of Trachea — Naso-Pharyngeal Illuminators — Antroscope — CEsophagoscope — CEsophageal Tubes 80-89
Chapter VIII
Direct Laryngoscopy. — Principles of Direct Laryngoscopy — Forehead Lamp for Direct Laryngoscopy — Kirstein's Autoscope — Advantages and Disadvantages of this Method — Contraindications — Inspection of Under Surface of Vocal Cords — Advantages of Direct Laryngoscopy in Surgical Operations — Claims for this Method — Direct Examination of Naso-Pharyngeal Cavity, 90-97
Chapter IX
Transillumination. — Various Methods of Applying Transillumination in the Nose, Throat and Ear — Antrum Illuminators — Voltolini-Heryng's Method — Davidsohn's Method — Garel's Method — Ruault's Method — Escat's Method — Advantages and Disadvantages of Each — Transillumination as a Diagnostic Measure 98-109
' CHAPTER X.
Transillumination (Cotuluded). — Transillumination in Normal Subjects — Usefulness in Noting Progress of a Case — Principle of Transillumination Illustrated — Transillumination of Nasal Septum, Frontal Sinus, Ethmoidal and Mastoid Cells — Of Larynx — In Locating Foreign Bodies 110-118
Chapter XI
Electro-Cautery. — Early History — Principal Methods of Obtaining Currents for Electro-Cautery — Chemical Battery, Storage Cells, Dynamos — Plunge Battery — Edison-Lalande Cell — Storage Battery and Methods of Charging — Shunt Rheostats — Transformers for Alternating Current — Motor- Dynamo, 119-131
Chapter XII
Electro-Cautery {C<mcluded), — Electro-Cautery Points — Requisite for Effective Battery — Electro-Cautery Handle — Connecting Cords — Interrupters — Foot-Switch — Application of Electro-Cautery — Superiority over Chemical Cauteries — Limitations — Electro-Caustic Snare — Snares with Compensatory Resistance — Methods of Using Electro- Caustic Snare .... 132-143
Contents. v
PACE
Chapter XIII
Electrolysis. — More Complicated than the Electro-Cautery — Decomposition of Water as an Instance of Electrolysis — Correct Milliampere- Meter Necessary — Tension Current Required — Storage Cells Impracticable — Polarity — Effects of Electrolysis on Various Animal Tissue — Unipolar and Bipolar Methods — Tolerance of Patient — Conditions in which Applicable . 144-15 1
Chapter XIV
Cataphoresis. — Variety of Names !>y which Known — Osmotic Theory — A Form of Electrolysis^ — Anions, Cations, Ions — Cataphoresis of Iodine, Morphine, Quinine and Cocaine — Early History — Experiments Demonstrating Principle — Cataphoresis of Guaiacol and of Guaiacol-Cocaine — Application in Goitre — Influence on Micro-Organisms 152-157
Chapter XV
Interstitial Electrolysis. — A Combination of Electrolysis and Cataphoresis — Experiments Demonstrating Principle — Irritative Effect of Commercial Copper — Prevention of Adherence of Electrolytic Needle — Effects on Tissues — Application in Epistaxis — Monopolar and Bipolar Methods — Catalysis — Summary of Catalytic Effects 158-163
Chapter XVI
Electro- Magnetic Appliances. — Therapeutic Effects of Magnetism — The Telephone^ — Application in Teaching Deaf-Mutes — Microphone for Testing the Hearing — Electro-Magnetic Laryngeal Tube Extractors — Electric Drill Motor — Burrs and Trephines — Motor with Flexible Arm — Automatic Brakes — Motor Used with Incandescent-Light System — Mechanical Nasal Saws, 164-178
Chapter XVII
Electro- Magnetic Appliances {Continued). — Massage in Oto- Laryngology — Principle of Massage — Effect on Circulation and Nutrition of Parts — Results of Michael Braun's Application of this Method — Forms of Movement for Massage — Preparation of Probes — Advocates and Opponents of this Method — Control Experiments — Vascular and Mechanical Stimulation . . 179-185
Chapter XVIII
Electro-Magnetic Appliances (Concluded). — Massage in Oto-Laryngology (Concluded). — Advantages of Mechanical Appliances — Intra-nasal Vibrators — Simultaneous Massage of Extensive Portions of Mucous Membrane — Massage in Pathologic Conditions of the Ear — Hand Telephone for Vibratory Massage of Middle Ear — Vibrator)' Massage in Meniere's Disease — Electric Tuning-Fork for Gelltf's Test — Pneumo-Massage of Ear — Violin-Vibrophone 186-193 vi Contents.
Chapter XIX. Page
Tumors of the Nose and Throat.— Electro-Cautery in Nasal Polypi—In Myxofibroma — Electrolysis in Angiomatous Tumors of Nose — In Lipoma — In Papillomata — Various Electro-Surgical Methods for Naso- Pharyngeal Polypi — Electro-Cautery — Electro-Caustic Snare — Electrolysis — Complications — Electrolytic Snare — Electrolytic Forceps — Advantages of Strong Currents in Electrolysis of Tumors 194-204
Chapter XX
Tumors of the Nose and Throat (Concluded). — Electro-Cautery in Ranula — Electro-Caustic Snare in Cancer of Tongue — Metallic Electrolysis in Vascular Tumors of the Mouth — In Dermoid Cysts — Advantages of Electro- Cautery in Larynx — Electro-Cautery in Lupus — In Tracheal Tumors — Malignant Tumors of Nose and Throat — Faradism — Cancer of Tonsil — Fibrosarcoma of Septum — Carcinoma of Vocal Cords — Electrolysis and Metallic Electrolysis in Malignant Tumors 205-213
Chapter XXI
External Nose. Hypertrophic Rhinitis. — Use and Abuse of Electric Methods in the Nostrils — Electro-Cautery^in Hypertrophic Rhinitis — Comparative Value of Electro-Cautery — Hyperesthetic Rhinitis — Complications from Use of Cautery — Fatal Effects — Reflex Disturbances — Synechia — Ear Complications — Epistaxis — Anosmia 214-222
Chapter XXII
Hypertrophic Rhinitis (Concluded), — Conservatism in Nasal Surgery — Electrolysis in Hypertrophic Rhinitis — Application of Monopolar Method — Bipolar Method — Contraindications — Relative Value of Electrolysis and Electro-Cautery — Electrolysis in Hypertrophy of Posterior Extremity of the Turbinals — Metallic Electrolysis in Hy])ertrophic Rhinitis — In Purulent Rhinitis — Vibratory Massage ........ 223-230
Chapter XXIII
Ozena (Fetid Atrophic Rhinitis). — Galvanism — Faradism — Vibratory Massage — Massage Combined with Electric Method — Objection to Electro-Cautery — Danger of Operations in Atrophic Nostrils — Cupric Electrolysis — Monopolar and Bipolar Methods — Success of Cupric Electrolysis — Complications — Electrolysis by Copper Bulbs 231-237
Chapter XXIV
Epistaxis. Anos.mia. Reflex Neuroses of Nasal Origin.— Galvanic Preferable to Faradic Current in Anosmia — Influence of Electric Current on Olfactory Nerve — Far.idic Current in Anosmia — Principle of Reflex Neuroses — Electro-Cautery— Consen'atism in Applying the Electro-Cautery — Spasmodic Cough of Nasal Origin — Hay Fever Complicated with Asthma — Galvanization of Pneumogastric Ner\'e in Asthma — in Hay Fever — Faradic Current in Asthma 23S-245
Contents. vii
Chapter XXV. Pacb
Deformities op the Nasal Septum. Nasal Synechia. Simple Ulcer op THE Nasal Septum. Foreign Bodiks. — Conditions of Nasal Septum Requiring OperatiTe Interference — Nasal Trephine — Mechanical Saws — Electro-Cautery and Electrolysis in Septal Deformities — Primary and Secondary Action of Electrolysis — Electrolysis in Nasal Synechia — Cupric Electrolysis in Simple Ulcer of Nasal Septum — Electro-Cautery in Tubercular Ulcers and Lupus of Nasal Mucous Membrane — Cupric Electrolysis — Telephone Indicator for Locating Foreign Bodies — The X-Rays .... 246-254
Chapter XXVI
Diseases of the Accessory Sinuses. — Cooper's Operation — Puncture by Means of Electro-Cautery — Electro-Chemical Method of Treatment — Ozone as a Remedial Agent — Method of Generation and Application — Canulas for Applying Ozone — Clinical Report of this Method — Action of Ozone on Micro-Organisms 255-259
Chapter XXVII
Diseases of the Pharyngeal, Faucial and Lingual Tonsils. — Electric Curette — Pharyngeal Bursa — Indications for Various Methods — Tonsillotomy by Cautery Dissection — By Electro-Caustic Snare — Snare with Comjjensatory Rheostat in Handle — Tubercular and Syphilitic Ulcers of Tonsils — Follicular Tonsillitis — Danger of Tonsillotomy — Indications for Various Methods of Operating — Varicose Veins at Base of Tongue . . 260-274
CHAPTER XXVHI.
Diseases of the Pharynx. — Electrolysis in Follicular Pharyngitis — Galvanism in Chronic Pharyngitis — Electro-Cautery and Metallic Electrolysis in Tertiary Syphilitic Ulceration of Pharynx — Galvanism in Indolent Mucous Patches — Pharyngo-Mycosis — Treatment by Cupric Electrolysis — Electro- Cautery in Uvulotomy — Paralysis of Palate — Testing Electric Reaction of Palate — Galvanic and Faradic Current in Differentiating between Central and Peripheral Lesions of Nerves — Galvanism and Faradism in Paralysis of Pharynx — Stimulation of Gustatory Nerve 275-280
Chapter XXIX
Neuroses of the Larynx. Diphtheria. — Effect of Galvanism on Muscles of Larynx — Laryngo-Stroboscope — Effect of Faradic Current — Bipolar, Monopolar and External Methods — Motor Points of Laryngeal Muscles — Stimulation of Recurrent Laryngeal Nerve — Of Facial, Pneumogastric and Phrenic Nerves — Paralysis of Larynx — Faradization — Galvanization — Vibratory Massage — Hysterical Aphonia, Acute and Chronic — Influence of Electricity on Voice — Electricity in Stammering — Objections to Electro- Cautery in Diphtheria — Effects of Electrolysis 281-291
Chapter XXX
Tubercular Laryngitis. — Rarity of Primary Laryngeal Tuberculosis — Treatment by Curettement — Electrolysis — Electro-Cautery — Advantages of Cataviii Contejits.
FAGB phoresis — Cupric Electrolysis — Superiority of Bulb Electrode — Indication for Cupric Electrolysis — Direct Laryngoscopy — Cases Treated by Cupric Electrolysis — Percutaneous Galvanism in Tubercular Laryngitis — Faradization 292-300
CHAPTER XXXL
Diseases of the Trachea and CEsophagus. — Electro-Cautery in Tracheotomy — For Removal of Tracheal Granulations — Catalysis in Stricture of Trachea — Electrolysis in Branchial Fistula — In Stricture of CEsophagus — CEsophagoscope — Indications for Electrolysis — Combination of Electrolysis and Dilatation — Investigation of Electrolysis in Strictures — Proper Application of Electrolysis — Influence of Continuous Current on Pneumogastric Nerve 301-306
Chapter XXXII
Diseases of the Thyroid Gland. — Galvanism in Goitre — Iodine Cataphoresis — Electrolysis — Monopolar and Bipolar Methods — Fibro-Cystic Goitre — Care in Application to Avoid Reflex Disturbances — Exophthalmic Goitre — Decrease of Electric Resistance — Galvanism in Basedow's Disease — Faradism — Treatment by Galvanization of Sympathetic Nerve — Galvanization of Pneumogastric Nerve — Central Galvanization 307-314
Chapter XXXIII
Application of Electricity to the Ear. Reaction of the Acoustic Nerve to Electric Excitation. — Electricity in Examination of Ear — Location of Dispersing Electrode — Difficulty of Stimulating the Auditory Apparatus — Greater Ease of Excitation in Pathologic Conditions— Ncftel's Experiments — Brenner's Formulas — Value of Galvanic Current in Diagnosis and Prognosis — Experiments Showing Presence of Electric Current in Auditory Nerve 315-325
Chapter XXXIV
Galvanism, Faradism, Static Electricity and Cataphoresis in Diseases of the Ear. — Sedative and Stimulating Effects of Galvanism — In Deafness of Children — Brenner's Formulas for the Reaction of .Auditory Nerve under Electric Excitation — Galvanism in Tinnitus — In Chronic Cases of Middle- Elar Catarrh — In Paralysis of Acoustic Nerve— Torpidity of Auditory Nerve — Effect of Faradism on Ossicular Chain — Application in Nerve Deafness — In Tinnitus — Effect of Static Electricity on Tensor and Laxor Muscles — Cataphoric Applications ......... 326-338
Chapter XXXV
Electrolysis, Electro-Cautery and Electric Massage in Ear Diseases. — The Trephine in Strictures of External Auditor)' Canal — Electrolysis in Connective-Tissue Strictures — Unipolar and Bipolar Methods — Electrolysis in Stricture of Eustachian Tube — Electro-Cautery in Myringotomy — In Granulations — In Furunculosis — Electro-Cauter)- for Foreign Bodies — Object and Effects of Electric Massage in the Treatment of Diseases of the Ear — Pneumo-Massage of the Drum and Ossicular Chain — Vibratory Massage in Suppurative Diseases ........ 339-345
Contents, ix
Chapter XXXVI
rAGB
The X-Rays. — Character of — Advantages in Surgery — Appliances — Theory of Crookes' Tube — X-Ray Induction Coils — Apparatus to be Used with Direct and with Alternating Incandescent-Light Currents — Instantaneous Air- Break Wheel — Tesla Transformer — Adjustable X-Ray Tubes — Stands — Skiagraphy — Photography by Means of Fluorescent Screen — Fluoroscopy — Advantages and Disadvantages 346-362
Chapter XXXVII
The X-Rays in Oto-Laryngology. — DiflSculty of Using X-Rays in Bony Tissues of the Head — Differentiation of Normal from Pathologic Tissue —Foreign Bodies in Nostrils — In Larynx — In Antrum — In CEsophagus — In Bronchus — Skiagraphy of Bones of the Face — Laryngo-Cryptoscopic Mirrors —Skiagraphy of Maxilla and Teeth — Of Antram of Highmore — Osseous Tumors — Examination of Pathologic Conditions of Lungs — Precaution in Applying X-Rays — Effects on Skin — Germicidal Properties 363-371
Index 393
LIST OF ILLUSTRATIONS.
PAGE
I. ToEPLER Electric Machine . 13
a. Grenet or Bichromate of Potash Cell 15
3. Gonda Cell 15
4. Law Cell 16
5. Axo Cell 16
6. Gravity Cell 16
7A. Partz Motor Cell 17
7B Mesco Cell 18
8. Chloride of Silver Dry Cell Portable Battery .... 21
9. Water Rheostat 21
10. McIntosh Portable Battery 21
11. Waite AND Bartlett Galvanic and Faradic Cabinet .... 22
12. McIntosh Galvanic and Faradic Cabinet 23
13. Storage Cell 24
14. Sorely Accumulator 25
15. American Storage Battery 25
16. Storage Battery Connected with Gravity Cells for Charging 26
17. Lamp Resistance 30
18. Scheppegr ell's Volt Selector and Shunt 31
19. Electro- Medical Wall Base for Constant Electric Currknt . 32
20. Cells Connected in Series 34
21. Cells Connected in Parallel Circuit 34
22. Massey Current Controller 37
23. Jewell Graphite Rheostat 38
24. MiLLi ampere-Meter 40
25. Jewell Milliampere-Meter 40
26. Weston Mil-am-meter 41
27. Vetter Upright Mil-am-meter . . 42
28. Polarity Changer .... 43
29. Kxifk-Switch Polarity Changer 43
30. Automatic Rheotome 45
31. Dispersive Copper Electrode 47
32. Arm and Neck-Band Electrode 48
33. McLntosh Carbon Electrode 48
34. Universal Electrode 49
35. Ear Electrode 49
36. Bi AURAL Electrode 50
37. Lnternal Laryngeal Electrode 50
38. Scheppegrell's Electrode for External Laryngeal Applications . 50
39. Scheppegrell's Single Electrodes 51
xi
Xll
List of Illustrations.
AND
40. Nasal Electrode
41. Scheppegrell's Universal Attachment Tip .
42. Insulated Conducting Cords ....
43. Simple Faradic Coil
44. McIntosh Faradic Coil with Adjustable Rheotome
Changer
45. Tripier Induction Apparatus ....
46. Dubois-Rkymond Faradic Coil ....
47. Magneto-Electric Machine
48. Sinusoidal Curve ........
49. McIntosh Sinusoidal Apparatus ....
50. Adjustable Incandescent Lamp ....
51. Scheppegrell*s Portable Laryngoscopic Lamp .
52. Enclosed Arc Lamp
53. Apparatus for Laryngeal and Post-Nasal Photography
OF Arc Light
54. Photograph of Larynx (in Inspiration)
55. Photograph of Larynx (in Phonation)
56. Photograph of Nares
57. Simple Lamp Resistance
58. Adjustable Lamp Resistance
59. Lamps Connected in Series
60. Lamps Connected in Multiple- Arc
61. Carter Duplex Transformer ....
62. Phillips' Head Lamp
63A. Head Mirror with Aitached Incandescent Lamp 63B. Electric Apparatus for Warming Sprays . 64. Scheppegrell's Electric Sterilizer
63. Electric Illuminator with Condenser
66. Electric Illuminator
67. Tongue Depressor and Electric Illuminator
68. Mouth and Throat Illuminator ....
69. Leiter's Pan-Electroscope
70. Laryngeal Mirror with Incandescent Lamp
71. Single Glass Prism for Obtaining Upright Image of
72. Kyle's Post-Nasal Illuminator ....
73. Modified (Esophageal Tube
74. Pan-Electroscoi'E Used FOR (Esophagoscopy
75. Forehead Lamp for Direct Laryngoscopy .
76. Kirstein's Autoscope
77. Tongue Depressor for Direct Laryngoscopy
78. Heryng's Antki'm Lamp
79. Chevalier Jackson's L.vmp for Transillumination
80. Examination of Antrim by Retro-Maxillary Illuminatic
81. Transillumination of Antrum of Highmore
83. Simple Cautery Hattkrv
84. Motor-Dynamo
85. Storage Hatfery and Charging Cells .
86. Transformer for Alternating Current
.arynx
Polarity
WITH Aid
PAGE
52 52
57 58
59 60
67 68 68 68
83 83 85 87 88
91 92
99 100
124 128
List of Illustrations. xiii
FAGB
87. Transformer with Motok-Dynamo 129
88. Direct Current Transformer 130
89. Scheppegrell's Set of Electro-Cauteries 132
90. Cautery Handle 134
91. Cautery Point and Handle 134
92. Cautery Handle with Wheel Attachment 134
93. SCHEPPEGRELL*S ELECTRO-CaUTERY HaNDLE 1 35
94. Thorner's Cautery Handle 135
95. Handle with Interrupter 136
96. Scheppegrell's Foot-Switch 136
97. Cautery Handle with Ecraseur Attachment 141
98. Schech*s Eleci ro-Caustic Snare 142
99. Electrodes for Cupric Electrolysis 159
100. Magneto Call Telephone 164
101. .Wetherla's Electro- Magnetic Tube Extractor .... 166
102. Electric Motor and Floor Push 168
103. Burrs and Trephines 168
104. Edison's Electric Motor with Rheostat 169
105. Edison's Electric Motor with Foot-Switch 170
106. Motor in Combination with White's Flexible Arm . . . .171
107. Potter's Nasal Saw 172
108. Brown's Nasal Saw 173
109. Roe's Nasal Saw 174
110. Black's Nasal Saw 174
111. Veeder's Nasal Saw 175
112. Scheppegrell's Mechanical Saw 176
113. Black's Intranasal Vibrator 187
114. Freudenthal's Instrument for Vibratory Massage . . . .188
115A. Lester's Mechanical Vibrator for the Ear 190
115B. Method OF Applying Vibrator TO Ear 191
116. Electric Tuning Fork 192
117. Jackson's Pneumatic Masseur FOR THE Ear 193
118. VuLPius' Electro-Cautery 195
119. Electrolytic Needle 225
120A. Scheppegrell's Double Electrolytic Needle 226
120B. Scheppegrell's Nasal Syringe 231
121. Electrode for Bipolar Electrolysis 248
122. Apparatus for Generation and Application of Ozone . . 257
123. Canul^ for Applying Ozone 258
124. Pynchon's Electro-Cautery Points 264
125. Knight's Electro-Caustic Tonsil Snare 265
126A. Cradle's Electro-Caustic Snare for Tonsillotomy . . . 267
126B. Loop for Cradle's Electro-Caustic Snare 268
127. Scheppegrell's Self-Adjusting Electro-Caustic Snare . . . 270
128. Laryngo-Stroboscope 282
129. Intra-Laryngeal Motor Points 284
130. Scheppegrell's Laryngeal Electrode and Handle for Cupric
131. Electrode for Direct Laryngoscopy 297
232. oesophageal electrode 303 xiv List of Illustrations.
PAGE
33. Bishop's Double Ear Electrode 315
34. Scheppegrell's External Ear Electrode 316
35. Liel's Ear Electrode 316
36. Eustachian Electrode 316
37. Vetter Motor and Dynamo Apparatus 340
38. Eustachian Catheter for Applying Electrolysis .... 342
39. WiLLYouNG Induction Coil 348
40. Static Apparatus for Operating X-Ray Tubes 349
41. X-Ray Apparatus with Edison-Lalande Cells 350
42. Willyoung X-Ray Apparatus with Rotary Break . . .351
43. Edison Instantaneous Air-Break Wheel 352
44. Knott X-Ray Apparatus 354
45. BowDOiN X-Rav Focus Tube 355
46. Adjustable X-Ray Tube 356
47. X-Ray Tube 357
48. X-Kay Tube (Diagrammatic) 357
49. Double X-Ray Tube (Diagrammatic) 357
50. Stand for X-Ray Tube 358
51. X-Ray Tube with Adjustable Stand 359
52. Fluoroscope 361
53. Skiagraph of Section of Lower Jaw 365
54A. Skiagraph of Antrum, Showing Foreign Body .... 366
54B. Skiagraph of Antrum (Negative) 366
55. Skiagraph of Head 368
ELECTRICITY
IN THE DIAGNOSIS AND TREATMENT OF DISEASES
OF THE NOSE, THROAT AND EAR.
ELECTRICITY IN THE DIAGNOSIS AND TREAT- MENT OF DISEASES OF THE NOSE, THROAT AND EAR.
Introduction
WHILE a number of more or less important works on the subject of electricity applied to medicine and surgery - have been published in recent years, still the subject of the application of this force to diseases of the nose, throat and ear has received but little consideration in these publications. Although the general character of the work may be excellent, it will usually be found that the references to oto-laryngology are not only meagre but vague and unreliable. A notable exception to this, however, is the monograph of Voltolini (i), who was an earnest investigator of this subject, especially in reference to the electrocautery. Chas. E. Sajous also, as one of the collaborators of the International System of Electro -Therapeutics (2), has given a brief synopsis of this subject and devoted 36 pages to its consideration.
In reviewing the literature of this subject, a large amount of material is met with. Many of these communications are of considerable importance, but others show a lack of knowledge of the fundamental principles of electric energy, which vitiates their value for statistic purpo-^es.
With a view of systematizing this subject, the author has considered it advisable to collect, as far as practicable, the more valuable part of these promiscuous publications on the application of electricity to rhinology, laryngology and otology, and, from a careful consideration of the merits of tht different methods suggested and of the results obtained, added to a considerable personal experience in this department, to present certain deductions and statistics which will form a useful guide to the student or practitioner in the application of electricity to this branch of medicine.
2 Introduction.
As far as can be learned by the writer, no systematic attempt has heretofore been made to present a work which is limited to the consideration of the application of electricity to diseases of the nose, throat and ear. Such a work it is hoped will form a convenient and useful reference book for the busy specialist and general practitioner, enabling them to learn from statistical information the merits of the different methods of treatment and applications that have been suggested, and to note the results of the various procedures that may be used in such cases. In such a manner only can we arrive at a scientific comprehension of this subject and obtain for it the position in electro-therapeutics and oto-rhino-laryngology to which it is so well entitled.
In order to obtain good results in electro-therapeutics, it must be applied by competent physicians — physicians familiar nT)t only with the anatomy, physiology and pathology of the human body, but also with electro-physics and electro-physiology. In this way only can the best result be obtained. Even in those cases in which electricity is applied to mechanical contrivances for its thermic or motor effect, it is important to have a sufficient knowledge of electro-physics in order to use these appliances satisfactorily. Unless the rudiments of electro-physics are well established, the physician is not only helpless in the first interruption of the current, or irregularity of the batteries, coils, rheostats etc., even when due to the simplest causes, but is even liable to inflict injury on his patient from his ignorance of these principles.
In referring to electricity in its application to dise.-MCs of the nose, throat and ear, it is not intended to be inferred that electricity is, by any means, a panacea for all diseases of this region. On the contrary, if, after a careful consideration of the results obtained by the various methods suggested, these are not found to be as reliable as those which have been obtained bv other means, this will be stated, and this negative information will be as valuable as those cases in which electricity has been found to be of benefit. On the other hand, electricity forms the basis of so many modes of applications and methods of treatment, and has such important possibilities not only in therapeusis, but also in the prognosis and diagnosis of many affections in this region, that it is important to systematize the results, which have been heretofore obtained, as landmarks for our work in the future.
When the comparatively recent date is considered since electricity has been used with any degree of accuracy and precision in
Int^-odiiction.
this department, the results are not only gratifying, but surprising. The enthusiast, who claims great results by a spt;cial method which he has foUowed, may err in his zeal ; but the work and study, which he gives to his favorite method, if faithfully reported, may furnish important points to be placed in the storehouse of our knowledge of this subject.
The most important consideration, however, is that our methods should be applied more methodically and the results reported with more regard to important details. The observer who reports his case only with reference to certain theories which he has formed. may give results which will contribute but little to our general stock of knowledge. But the conscientious worker who reports his results whether good or bad, who specifies points in the treatment of the case whether he understands them or not, and who applies himself more to facts than to theories, will add not a little to our practical knowledge.
But a few years ago, a prominent writer (3) stated that the technical knowledge of electricity will soon be no longer needed, as primary batteries will soon be a thing of the past, and we will receive the electric energy required in surgery from central stations or from dynamos. This is a dangerous doctrine to teach the student or the practitioner of medicine, as its observance might lead to disastrous results,
A physician ignorant of the elements of electricity and its application in pathologic conditions resembles some of the older practitioners, who, from their inability to use it, refuse to admit the utility of the stethoscope, and who, in consequence, fail to take advantage of this means of diagnosis with which modern discovery has provided them.
In referring to the difference made by physicians in the application of therapeutics and of electro-therapeutics, William Harvey King (4) states, with much truth, that many physicians use electricity simply because they have heard that this agent is good for certain conditions. He may even take the trouble to look up how it is to be given and the kind of electricity, whether faradic or galvanic. He does not, however, know anything about the battery itself, and knows nothing of the action of the coils constructed of wires of different lengths and sizes, or any other part of the physics or physiology of electricity. He, therefore, does not recognize the necessity of being as careful in selecting them as he is of his drugs.
4 Inirodiuiion.
The worthlessness of many reported cases is also complained of by C. M. Haynes (5), on account of their lack of details. He insists upon the necessity of the following points in these cases :
1. The method of applying the current ; whether general or local, labile or stabile, continuous or interrupted.
2. The kind of current used.
3. The direction of the current and location of the electrodes.
4. The length and number of the sittings, and the interval between these sittings, and the power of the battery current used.
These are important points to be observed, and their omission frequently vitiates a report which might have been of importance had proper attention been given to its details.
Electro-therapeutics covers a large field and the farther we advance in the study of its methods, the more we appreciate the many beneficial results which may be obtained from its scientific application. We can relieve pain not only by the direct use of galvanism, but also by the cataphoric application of anaesthetizing chemicals. We can increase absorption and stimulate torpid metabolic processes ; secretions may be excited, or excessive secretion modified ; muscular action may be stimulated and nerve activity revived. We can use it for arresting hemorrhages, for destroying tumors, enlarging strictures, and healing ulcerations. These are among the various effects which may be obtained by the proper use of this remarkable agent.
To obtain satisfactory results, however, it is as important to thoroughly understand the principles involved in the application of electro- therapeutics and the various known properties of electric energy, as it is to be familiar with the physiologic and pathologic conditions of the parts to be treated. The physician who attempts to apply electro-therapeutics, or even to perform an operation in which electricity is the motive, chcmic or thermal agent, without understanding the principles involved, and who is unable to recognize the various conditions which may contraindicate the application, is assuming an unjustifiable risk.
In medical therapeutics, where the chemicals are prepared by reliable houses, and where the prescriptions are compounded by druggists who have been specially trained in this work, the administration presents no very great difficulty. In electro-therapeutics, however, we are compelled very often to be the manufacturing chemist, distributing agent, the druggist and the physician. We must be able to distinguish the various forms of
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electric energy to be used, to understand the apparatus with which they are to be applied, and the manner in which the instruments should be used ; the rheostat with which the strength of the current is controlled, and the meters and scales by which the current is measured.
There are also certain physical conditions of the patient to be considered. It is important to know the difference in the applications to the skin and to the mucous membrane, and even in the different conditions of these tissues. The galvanic current that would be soothing, stimulating and beneficial to the moist mucous membrane, might be irritating and injurious to a dry and atrophic membrane, and the electrodes should be prepared with regard to these conditions.
There are also certain variations in the resistance of the patient to be remembered, and the physical condition has an important bearing. The part of the body to which an application is to be made demands consideration, and the tissues to be traversed by the current in its passage from the active to the dispersing electrode, as in the unipolar method of electrolysis.
This knowledge can be obtained only by a thorough understanding of the first principles of electric energy, familiarity with the various known methods, and personal experience in their application. Without such knowledge, the results will be unscientific, unreliable and frequently not only ineffective but even harmful.
CHAPTER I. General Principles
WHILE the exact nature of electricity is still unknown, scientists agree, in the main, that it is a form of motion similar to light and heat, and that it differs from these simply in the manner and form of the vibrations. The interchangeability of electricity, light, heat and motion favors this theory, which is also supported from a mathematical standpoint.
An every-day example of the transformation into different forms of energy is shown in our commercial electric systems^ The coal, whose potential energy was derived from the sun in primaeval ages, gives up its heat to the water in the boiler, and this thermal energy is transmitted into motive-power in the cylinder of the engine. This motive-power is transformed in the dynamo into electric energy, which is carried by means of conduits to the various parts of the city, and may be exchanged at will into light, as in the incandescent or arc lamps; heat, as in the electric culinary utensils and the various heating methods used in the arts; magnetism, as in the telegraph, or motive-power through motors which now have such a wide range of usefulness^ the electric street-car systems being a good example of this principle.
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