,transcriber's ,notes3 ,text enclosed by underscores is in italics 7italics71 and text enclosed by equal signs is in bold 7bold74 ,sidenotes are identified as3 ,,sn3 text of sidenote4 ,additional ,transcriber's ,notes are at the end4 99 99 99 99 99 ,,how ,,to ,,use ,a ,,galvanic ,,battery ,,in ,,medicine ,,and ,,surgery4 99 99 99 99 99 ,,how ,,to ,,use ,a ,,galvanic ,,battery ,,in ,,medicine ,,and ,,surgery ,a ,discourse ,,delivered ,,before ,,the ,,hunterian ,,society4 ,,by ,,herbert ,,tibbits1 ,m4,d4 ,,fellow ,,of ,,the ,,royal ,,college ,,of ,,physicians ,,in ,,edinburgh2 ,,honorary ,,member ,,of ,,the ,,new ,,york ,,society ,,of ,,neurology ,,and ,,electrology2 ,,late ,,honorary ,,medical ,,superintendent ,,of ,,the ,,national ,,hospital ,,for ,,the ,,paralysed ,,and ,,epileptic1 ,,oueen',s ,,square1 ,,bloomsbury1 ,,and ,,of ,,the ,,medical ,,society ,,of ,,london2 ,,member ,,of ,,the ,,clinical1 ,,ophthalmological1 ,,harveian ,,and ,,pathological ,,societies2 ,,founder ,,of1 ,,and ,,senior ,,physician ,,to1 ,,the ,,west ,,end ,,hospital ,,for ,,diseases ,,of ,,the ,,nervous ,,system2 ,,and ,,medical ,,officer ,,for ,,electrical ,,treatment ,,to ,,the ,,hospital ,,for ,,sick ,,children1 ,,great ,,ormonde ,,street1 ,,etc4 ,,etc4 ,,third ,,edition ,,revised1 ,,and ,,incorporating ,,three ,,lectures ,,upon ,,electro-,,therapeutics ,,delivered ,,by ,,the ,,author ,,at ,,the ,,national ,,hospital ,illustration ,,london3 ,j4 ,a4 ,,churchill1 #aa ,,new ,,burlington ,,street4 #ahhf4 ,,note ,,to ,,the ,,third ,,edition4 ,this ,discourse was first published in compliance with the request of several of those who heard it delivered1 and who expressed to me an opinion that busy practitioners might perhaps be glad to have at hand1 and in small compass1 such information as it contained4 ,it was obviously impossible to do more in so limited a time than to make a general reference to the therapeutic uses of electricity2 and the most that ,i attempted in this direction was to recall to the recollection of my audience those conditions of disease in which the application of electricity would seem--without doubt--to be required2 and to indicate the methods of application most generally useful4 ,the construction of apparatus can not be understood from verbal or written description alone2 and ,i appended to the text certain notes1 and illustrations of the instruments which ,i submitted to the ,society4 ,with the ,second ,edition ,i incorporated three ,lectures which ,i delivered at the ,national ,hospital for the ,paralysed and ,epileptic2 and to this ,edition ,i have appended such additional matter as ,i believe will prove useful to the student4 ,i may add that ,i have endeavoured1 as was said by a deceased physician1 8to paint electro-therapeutics not imperfectly1 but1 as it were1 in miniature30 and that while ,i have carefully revised every page1 and have noticed all real improvements introduced to the profession since the ,first ,edition1 ,i have kept the book a small book3 and ,i venture to hope a book easily to be understanded by the multitude of practitioners who ask daily what instruments to use1 and when1 and especially how1 to use them4 ,these questions ,i have endeavoured to answer in the following pages1 which contain such details1 and such details only1 as ,i believe it essential for the practitioner to master4 #fh1 ,,wimpole ,,street1 ,w4 ,december1 #ahhe4 ,,contents4 ,,note ,,to ,,the ,,third ,,edition4 ,,lecture ,i4 ,,electrical ,,instruments4 ,,preliminary ,,remarks4 ,,the ,,different ,,varieties ,,of ,,electricity4 #a4 ,,franklinism4 ,method of ,generating4 ,the ,plate ,machine4 ,winter's ,machine4 ,carr's ,machine4 ,the 8,bischoff0 ,gas ,engine4 ,the 8,hand ,fly-,wheel40 ,accessories ,required4 ,its ,administration4 7a7 ,electro-,positive ,bath4 7b7 ,electro-,negative ,bath4 7c7 by ,sparks4 #b4 ,,voltaism4 ,points of ,distinction between the ,voltaic and ,faradaic ,currents4 ,the ,essentials of a ,voltaic ,battery4 ,the #dj-;,cell ,battery4 ,the ,galvanometer as an aid to the ,dosage of ,electricity4 #c4 ,,faradism4 ,the ,essentials of a ,faradaic ,instrument4 ,description of a ,faradaic ,instrument4 ,the ,combined ,hospital ,battery4 ,,the ,,accessories ,,of ,,electrical ,,apparatus4 ,,lecture ,,ii4 ,,methods ,,of ,,applying ,,electricity4 ,r,,sum ,,of ,,first ,,lecture4 ,,generalized ,,electrization4 ,the ,positive ,charge4 ,the ,electric ,bath4 ,general ,faradization4 ,central ,galvanization4 ,,localized ,,voltaization ,,and ,,localized ,,faradization4 ,direct ,muscular ,electrization4 ,indirect 0 0 ,different kinds of ,rheophores4 ,importance of exactitude in administering a ,constant ,current4 ,,cutaneous ,,electrization4 7a7 ,the ,electric ,hand4 7b7 ,metallic ,conductors4 7c7 ,the ,wire ,brush4 ,,electrization ,,of ,,internal ,,organs4 7a7 of ,rectum and ,muscles of ,anus4 7b7 of ,bladder4 7c7 of ,uterus4 7d7 of ,larynx4 7e7 of ,male ,genitals4 ,,electrization ,,of ,,central ,,organs ,,of ,,nervous ,,system4 7a7 of the ,brain4 7b7 of the ,sympathetic4 7c7 of the ,spinal ,cord4 7d7 of the ,retina4 7e7 of the ,auditory ,nerve4 ,,precautions ,,to ,,be ,,observed ,,in ,,all ,,medical ,,applications ,,of ,,electricity4 ,,lecture ,,iii4 ,,electricity ,,in ,,diagnosis ,,and ,,treatment4 ,a4--,electricity in ,diagnosis4 ,,limitation ,,of ,,electricity ,,in ,,diagnosis4 ,,method ,,of ,,testing ,,farado-,,irritability4 0 ,,voltao-,,irritability4 ,,rule ,,for ,,strength ,,of ,,current4 ,,diagnosis ,,when ,,irritability ,,is ,,normal4 diminished4 increased4 diminished to ,faradism and increased to ,voltaism4 of ,peripheral from ,central ,disease4 of commencing ,paraplegia from ,locomotor ,ataxy4 of ,real from ,feigned ,disease4 ,,electricity ,,as ,,proof ,,positive ,,of ,,death4 ,b4--,electricity in ,treatment4 ,,limitation ,,of ,,electricity ,,as ,a ,,remedy4 ,,franklinization4 7a7 in ,facial ,neuralgia4 7b7 in ,sciatica4 7c7 in ,facial ,spasm4 7d7 in ,emotional ,aphonia4 7e7 in ,hysterical ,hypersthesia4 7f7 in ,tremor4 ,,note ,,upon ,,recent ,,additions ,,to ,,our ,,knowledge ,,of ,,the ,,benefit ,,of ,,franklinization ,,in ,,diseases ,,of ,,debility4 ,,voltaization4 ,the 8,constant ,current40 ,possesses an ,influence 8sui generis40 ,,electrization in ,neuralgia4 in ,fatigue ,diseases4 in ,electrotonus4 its ,resolvent ,effects4 in ,electrolysis4 in ,impotence4 in ,gout4 in ,rheumatic ,arthritis4 in ,muscular ,rheumatism4 in ,general ,debility4 in ,atrophic ,paralysis4 in ,infantile ,paralysis4 in ,traumatic ,paralysis4 in ,lead ,palsy4 in ,facial ,paralysis4 in ,wasting ,palsy4 in ,hemiplegia4 ,,electrization as a ,direct ,application to the ,brain4 in ,spinal ,paraplegia4 in ,paraplegic ,constipation4 in ,incontinence of ,urine4 in ,hysterical ,paralysis4 in ,locomotor ,ataxy4 in ,insanity4 in ,diseases of ,women4 as an ,emmenagogue4 in ,inertia ,uteri4 in ,post-partum ,hmorrhage4 in ,uterine ,neuralgia4 in ,sterility4 in ,paralysis of ,nerves of ,special ,sense4 ,r,,sum ,,of ,,the ,,general ,,principles ,,of ,,electro-,,therapeutics4 ,,concluding ,,remarks4 99 99 99 99 99 ,,how ,,to ,,use ,a ,,galvanic ,,battery ,,in ,,medicine ,,and ,,surgery4 ,,lecture ,i4 ,,electrical ,,instruments4 ,,mr4 ,,president ,,and ,,gentlemen1 ,,sn3 ,preliminary ,remarks4 ,when your ,council did me the honour to ask me to bring before you the subject of ,electro-therapeutics1 ,i felt that the invitation was addressed rather to the ,hospital to which ,i am attached than to myself1 seeing that to it belongs the merit of having been for some years the pioneer and outpost1 so to say1 in this metropolis of the scientific and methodical application of electricity to the alleviation and removal of disease2 and that we are indebted to one of its distinguished physicians for a remarkable investigation into animal electricity1 and the demonstration that much of what we have been accustomed to attribute to a 8vital principle0 may1 in reality1 be the effect only of electrical charge and discharge#a 7a valuable contribution to the correlation of the ,physical ,forces72 and to my predecessor for the discovery of the special influence of voltaic currents in certain forms of paralysis4#b ,as it is one of our objects in our practice here to study the scope and the limits of electricity as a remedy in disease1 it seemed to me not inappropriate to devote my first ,lectures to electro-therapeutics2 and the more so1 as few medical men have a practical knowledge of the subject2 and ,i fear that the profession generally1 through lacking this practical knowledge1 are to some extent responsible for the utter and astounding recklessness with which the laity--ever ready to rush in where physicians fear to tread--are prone to apply painful and dangerous electrization1 not to themselves1 but to their suffering friends2 while it is still too common for the medical practitioner 7as quoted by ,golding ,bird upwards of forty years ago7 to consider that when his fiat has gone forth 8let the patient be electrified10 he has done all that is necessary1 while the patient usually carries out this mandate by the purchase of a rotary magneto-electric machine1 and by using it according to the directions of its maker1 who is generally about as well fitted to teach its application in disease as is the maker of an amputating knife to operate with it6 ,the almost complete absence in the medical schools of the great hospitals of opportunities for an adequate study of electro-therapeutics1 the importance of the subject1 and the widespread attention that it is awakening throughout the profession1 have also determined me to sketch as briefly as is consistent with clearness the present position of the science and practice of medical electricity1 and especially of its practice4#c ,electricity1 ,gentlemen1 is by no means one of those remedies that1 failing to do good1 is little likely to do harm4 ,on the contrary1 in injudicious hands1 it is potent for evil1 while the benefit to be derived from it is in exact proportion to the judgment and care with which it is administered4 ,moreover1 the results of its employment are dependent1 more than with any other therapeutic agency1 upon the methods by which it is applied--methods that should be familiar1 not alone to a few specialists1 but to every practitioner4 ,addressing you who are engaged in active practice1 with little time to devote to medical electricity1 it will1 ,i think1 be more acceptable for me not to weary you with a tedious discourse upon the elementary principles of electricity1 for the practical application of these matters concerns rather the instrument-maker than the medical practitioner1 and ,i shall discuss none of them1 except incidentally1 and with precise reference to their application to medicine4 ,besides1 we know little of them1 and ,i cannot forget that ,faraday said that 8he once thought he knew something about electricity1 but the more he investigated it the less he found he understood it40 ,let us then be content with its definition as a 8,,force10 8pervading all nature1 latent in every substance1 and liable at any moment to be excited by mechanical or chemical means40 ,nor do ,i propose to make these ,lectures in any sense exhaustive1 but1 on the contrary1 to include in them only such information as is essential1 and such as you may readily1 and without effort1 retain in your memory4 ,i shall direct especial attention to practical points which are of importance to the successful use of electricity2 for from non-observance of small details of application many failures have resulted1 the treatment getting a measure of discredit1 which in strict justice should have attached only to the operator4 ,in the present ,lecture ,i shall consider instruments1 their construction and management1 a dry subject1 but an essential one1 the first requisite of a good workman being complete familiarity with his tools1 lacking which he will be the victim of constantly recurring annoyances and difficulties2 for although the present position of electro-therapeutics is largely due to improved methods of administration1 these methods would be impossible with faulty instruments1 while1 on the other hand1 the most perfect instruments require a certain amount of skill and care in their management1 and some acquaintance with at least the mechanical details of their construction2 and without this rudimentary knowledge it is also impossible to usefully compare one instrument with another4#d ,my second ,lecture will be devoted to the different methods of applying electricity1 and my third and last to its uses in the diagnosis and treatment of disease4 ,,sn3 ,varieties of ,electricity4 ,we make use of three varieties of electricity in medicine4 ,firstly1 of static or friction electricity1 the electricity of glass and amber1 appropriately called from its early investigator1 ,franklinism4 ,secondly1 of the electricity of chemical action1 ,galvanism1 or better1 ,voltaism1 the 8,constant ,current40 ,thirdly1 of ,faradism1 the induced currents of momentary duration1 which are generated or induced1 in a coil of wire by the action upon it1 under certain circumstances1 of a magnet1 or of a ,voltaic current4 ,,franklinism4 ,franklinism1 sometimes of the utmost value1 and far surpassing1 in certain cases1 any other form of electricity1 has some inconveniences in its application1 and has hitherto been little used but by specialists4 ,recent improvements in ,franklinic instruments have1 however1 largely removed these inconveniences1 and have placed at the general service of the profession a remedy of much good and still greater promise4 ,the fundamental requisite in all ,franklinic machines1 consists in the rotation of a glass plate against a leathern or other rubber1 and the accumulation of the resulting electricity upon a metallic receiver1 insulated by a non-conducting support1 usually of glass4 ,,sn3 ,franklinism ,discarding the primitive cylinder machine1 now long since disused1 we will firstly consider the plate machine in which the electricity arising from the friction of the rotating glass plate against the upper and lower cushions1 is collected by two brass arms and distributed to the brass conductor1 from which they branch out1 and which is insulated by a glass support4 ,illustration3 ,,fig4 #a4 ,plate ,electrical ,machine and ,glass-legged ,stool4 ,the machine should be fixed upon a firm stand that it may be quite steady during rotation1 and be screwed to a heavy painted deal table1 as is shown in ,fig4 #a4 ,illustration3 ,,fig4 #b4 ,winter's ,machine4 ,when very seldom used1 and where expense is a consideration1 very fair results may be obtained from a ,winter's machine with a plate of only #ae inches in diameter1 and which is easily carried4 ,in this instrument1 ,fig4 #b1 the fact that the quantity of electricity which may be accumulated upon a conductor is dependent upon its size has been most ingeniously applied1 the surface of the conductor being enormously increased by the insertion into a large wooden ring of a core of thick iron wire4 ,electricity accumulates upon the wire1 and is prevented from escaping by the insulating wooden covering4 ,but in the daily or frequent use of ,franklinism it is essential1 equally for the comfort of the operator1 as for the benefit of the patient1 that the most efficient apparatus should be provided4 ,the one delineated in ,fig4 #c1 and which ,i habitually use1 is that known as ,carr's1 but ,i have modified it by having attached to it a second accumulator1 or conductor 7the first time1 ,i am led to understand1 that such an improvement has been added to any such machine74 ,this arrangement admits of the patient receiving the charge of either positive or negative electricity--a condition said by some physicians to be of primary importance4 ,illustration3 ,,fig4 #c4 ,static ,machine with ,gas ,engine and ,insulating ,stool4 ,there are other machines1 but ,i do not propose to weary you with their descriptions4 ,when any ,franklinic apparatus is in use its plate or plates should be evenly and uniformly rotated1 and it is much better to have this done mechanically rather than by a man or maid-servant4 ,i use a 8,bischoff's0 gas engine1 shown to the right hand in ,fig4 #c4 ,it consists of a cylinder1 surmounted by a hollow column serving as a guide to the piston4 ,from the extremity of this column there is a very long connecting rod which acts upon the crank of the shaft of the fly-wheel and driving-pulley4 ,when the piston ascends it draws in during four-tenths of its course a mixture of air and gas from the pipes4 ,a little before the piston has ascended half-way a gas jet ignites the mixture4 ,there is a slight explosion without the least effect on the sides of the cylinder1 but sufficiently strong to push the piston and cause it to complete its course4 ,in consequence of this movement the piston is raised and acts on the connecting rod1 forcing it upwards and half turning the fly-wheel4 ,on account of the speed acquired1 and of the impulse given1 the fly-wheel continues its course by means of the crank and connecting rod1 and sends the piston to the starting-point again4 ,then it ascends again1 taking in a fresh charge of air and gas1 motion being imparted anew to the driving shaft by every revolution of the engine4 ,an engine of #b-man power1 with an altitude from the ground to the top of the column of #d feet1 and with a fly-wheel measuring #b feet #f inches in diameter1 is amply sufficient for every purpose4 ,it works evenly and without noise2 it is absolutely free from danger1 and it is placed instantly in or out of action by merely igniting or extinguishing a single gas jet4 ,but it is remarkable that no one seems to have suggested--even before the gas-engine era--that a 8fly-wheel0 with a pulley would obviate the old difficulty of the unsatisfactory rotation of the ,plate machine4 ,going into a hair-cutter's shop ,i found the apparatus1 figured to the left of ,fig4 #d1 standing in the shop to work the customary 8hair brushing machinery0 instead of its being1 as is usual1 fixed upon an upper floor4 ,i obtained one1 and fitted it in the manner shown1 to a ,carr's machine4 ,the fly-wheel is so heavy that it can be rotated by the operator without the aid of an assistant1 by his giving the handle an occasional 8swing round40 ,its momentum then keeps it revolving a sufficient number of times before the next 8swing0 is required1 to enable him to leave it and attend to his patient4 ,the manner in which the band from it is attached to a small wheel in rear of the ,static machine is also shown in the ,figure4 ,illustration3 ,,fig4 #d4 ,fly-,wheel and ,static ,machine4 ,in ,fig4 #c the patient is being 8charged0 with positive electricity1 or1 as the electro-therapeutists of fifty years ago would have said1 8he is taking an electro-positive bath10 by being insulated and connected through the metallic rod held in his hand with the accumulator upon which the positive electricity is stored1 while the negative electricity is 8run off0 by a brass chain leading from the negative accumulator to the ground4 ,if the process were reversed1 the positive accumulator1 being connected with the ground1 and the patient with the negative one seen at the top of the machine1 he would be taking 8an electro-negative bath20 for we make him1 as it were1 a part of each accumulator as the case may be2 its accumulated electricity passes to him and he becomes charged4 ,if the air were perfectly dry he would continue 7as he is insulated7 in this charged condition1 but owing to its contained moisture the electricity rapidly leaves him1 and to maintain the charge it is necessary that the plate of the machine should be kept in constant rotation4 ,indeed1 the escape of electricity is so rapid that to get the best action we must have a fire in the room1 and before use well rub the plate1 the insulating supports1 the legs of the stool1 and all the glass parts of the apparatus with a warm and dry piece of flannel4 ,this is of importance1 and however dry the day1 should as a rule never be neglected4 ,by smearing the inside of the cushions of the machine with a little paste1 composed of an alloy of mercury and tin 7technically known as 8amalgam071 mixed with a little tallow1 the amount of electricity is much increased1 but care should be taken not to smear the cushions with too much1 which had better be bought ready prepared4 ,a piece about the size of a small grape for each of the cushions will be enough1 and no more need be added for two or three weeks4 ,always scrape off old amalgam before adding new4 ,the cushions should be screwed sufficiently tight to slightly 8grip0 the plate1 and if it is found that notwithstanding having rubbed the glass of the apparatus as above directed1 the instrument is not supplying a sufficient quantity of electricity1 remove the cushions and warm them thoroughly4 ,it is impossible to be too careful that everything is warm1 clean1 and dry1 for the great obstacle that exists against the extended use of ,franklinism is found in this difficulty sometimes present1 from neglect of the above precautions1 in getting efficient action4 ,but even on a foggy day the instrument1 with proper care1 may be made to act well4 ,the operator should also remember that dust must be sedulously guarded against4 ,a few drops of petroleum may be sprinkled upon the table1 and their vapour condensing upon the machine will aid in protecting it against moisture4#e ,there will also be needed two or three lengths of brass chain1 or of copper wire1 and a stool about #d feet by #b feet1 with four glass balls or legs4 ,a stool of this size admits of a chair being placed upon it1 as in ,fig4 #c1 and it will be also useful for certain applications of voltaism1 which will be mentioned later on4 ,four glass jars are also needed with which to insulate an ordinary couch4 ,illustration3 ,,fig4 #e4 ,improved ,dischargers and ,connecting ,rod4 ,,fig4 #e;a4 ,a chair1 insulated by being screwed to a glass platform1 as in ,fig4 #e;a1 running on castors1 is an improvement upon the old-fashioned glass-legged stool4 ,,sn3 ,franklinization by ,sparks4 ,in ,fig4 #c1 the electricity is escaping from all points of the skin1 but if it is desired to localize somewhat this escape along the course of certain nerve branches1 or otherwise1 but to avoid shock1 a brush may be slowly passed by the operator almost1 but not quite1 in contact with the skin4 ,a series of rapid and successive reunions of the electricity with each bristle of the brush takes place1 generating a current of cold air perceptible to the patient4 ,i habitually use for this application an ordinary clothes-brush4 ,if while in connection with the conductor any object 7the knuckles will do7 is brought sufficiently near to the patient for his contained electricity to overcome the resistance of the intervening stratum of air1 he is 8discharged0 with a spark4 ,this is ,franklinization by sparks1 and is accompanied by a certain slight amount of 8shock40 ,in ,fig4 #e1 improved 8dischargers10 and a convenient metallic connecting rod are shown4 ,the ball terminations of the dischargers should vary in size1 for within certain limits1 the larger the ball the more intense the spark2 with the pointed end the spark is very small2 with the discharger terminating in many small metallic points still smaller1 and with a similar discharger made of wood1 a luminous glow alone results1 and no spark4#f ,i shall discuss1 in my third ,lecture1 the therapeutic values of ,franklinism4 ,,voltaism ,,or ,,galvanism4 ,,sn3 ,voltaism4 ,the ,voltaic current is a continuous current4 ,unless artificially interrupted1 the electricity flows in an unbroken stream until the battery is exhausted4 ,the current will gradually lessen in power until it ceases1 but there will be no break in it1 and no change in its direction1 which is uniformly from the positive to the negative pole4 ,,sn3 ,points of distinction between the ,voltaic and ,faradaic ,currents4 ,it is important to recollect these points1 for they constitute the chief physical distinction between the ,voltaic and the ,faradaic--or1 as it is sometimes called1 the ,induced current4 ,this latter is not1 strictly speaking1 a 8current10 but a rapid discharge or succession of momentary shocks1 each perfectly distinct in itself1 and separated by an appreciable interval of time from its fellows4 ,,sn3 ,voltaic ,cells4 ,in electrization1 a source of electricity is of course necessary1 and this is furnished by a cell or cells1 with contained elements and chemicals2 and1 until a few years ago1 it was impossible to get a portable cell that remained always in order and ready for use4#g ,,sn3 ,requisites of a ,portable ,battery4 ,the requisites of a portable battery are that it should be really portable1 always ready for use1 and little liable to get out of order4 ,such batteries may be divided into two classes3 firstly1 those in which the elements are either lowered into the exciting fluid or the fluid is lifted to them1 as in the instruments of ,sthrer1 ,weiss1 and almost all other makers2 and1 secondly1 those in which the elements remain immovable in their cells1 and of these the ,leclanch1 the ,gaiffe-,clamond1 and the chloride of silver1 are to be generally preferred to any of the first-named construction1 for they admit of the cells being so nearly sealed up that no fluid can be spilt by any movement except turning the battery quite upside down2 while the somewhat common accident with batteries of the first-named construction--viz41 destruction of the plates by leaving them in the acid1 with its anything but agreeable result of a considerable expense to replace them1 is obviously impossible4 ,the only disadvantage they possess is that when exhausted it is necessary to send them to the maker to be recharged1 while the owner can keep the first-named variety in order himself4 ,efficient cells are1 however1 but a first step to the perfection of electrical apparatus1 and the mechanism by which the current is brought into use and graduated1 and the general accessories of the instrument1 are of at least equal importance4 ,the instruments which ,i am about to describe1 have been designed by myself1 and may be obtained from ,mr4 ,hawksley1 ,surgical ,instrument ,maker1 ,oxford ,street4 ,it is claimed for them that they place at the service of the busy practitioner a battery that with ordinary care 7and no instrument will remain in order without this7 may be kept upon his consulting-room table1 always as available to his service as his stethoscope or ophthalmoscope4 ,three kinds of batteries are constructed3--,a ,voltaic battery1 with any required number of cells1 from #ae to #ajj2 a ,faradaic battery2 and a ,combined battery1 uniting both ,voltaic and ,faradaic currents4 ,illustration3 ,,fig4 #f4 #dj-;,cell ,voltaic ,battery4 ,a4 ,guard preventing the lid being shut1 unless the needle of the dial points to 8#j01 and the instrument is out of action4 ,b4 ,cells shown by the removal of the compartment1 ,h1 for sponges and accessories4 ,c4 ,bolt to secure the element board1 which moves upon the hinges1 ,d4 ,d1 ,d4 ,hinges of element board4 ,e4 ,dial plate regulating the strength of the current4 ,the needle1 when the battery is not in use1 should cover the stud1 8#j10 seen to its left4 ,f4 ,commutator of the poles4 ,the poles1 ,n and ,p1 are seen through holes cut in the element board4 ,g4 ,key by which the current can be shut 8off0 or 8on10 without change of position of the conductors4 ,it can also be used by vibrating it backwards and forwards as an 8interrupter40 ,i1 ,i4 ,binding screws1 to which are attached the conducting wires and sponge-holders1 c4 ,,sn3 ,the ,voltaic ,battery4 ,the ,voltaic ,battery 7see ,fig4 #f1 p4 #bj7 has its cells arranged in the interior of a mahogany case1 and in use they are hidden from view and from danger1 but ,i now partially expose them by removal of the tray for holding the sponges and accessories4 ,their connecting wires are brought across the under surface of the element board1 which is made to move upon hinges that1 when necessary1 the cells may be examined1 but at other times this element board is held in position by a bolt1 and it should never be needlessly disturbed4 ,these wires conduct the current through the graduating dial1 and the position of the needle of this dial determines from how many of the cells the electricity shall be allowed to reach the binding screws1 and from them1 by way of the conductors1 sponge-holders1 or electrodes1 the body of the patient1#h or whether it shall be entirely shut off1 as is the case when the battery is not in use1 and when the needle stands at 8#j0 7,fig4 #g74 ,when the needle points to any stud numbered on the dial1 the number of cells marked on that stud are brought into action1 and the needle is made just wide enough to touch one of the studs before it breaks contact with the preceding one1 and thus the current may be increased or decreased in power without shock1 and while the electrodes are held applied to the patient2 but if it were not so made a series of painful shocks would be communicated whenever the current was increased or decreased4 ,should the needle1 from forgetfulness1 be left when out of use in any other position than at 8#j10 a guard upon the lid of the instrument prevents its being shut1 and the operator has his attention called to his inadvertence4 ,a ,voltaic alternative1 or change of direction of the current1 is sometimes required in treatment1 and the commutator of the poles enables this to be accomplished without alteration in the position of the conductors4 ,by pushing forwards or backwards the handle which moves a lever working below the element board the current is instantly reversed1 and the alternation of the letters 8,p0 and 8,n0 seen through holes cut in the element board indicates at once not only that there has been a change of poles1 but which pole is at the moment negative or positive2 whereas in all previous instruments1 when the poles have been changed1 there has either been no letter marking them1 or this letter has really been wrong1 and one has had to remember this2 and under such circumstances1 and examining patients in rapid succession1 momentary confusion of the poles was very liable to occur1 even to a practised operator4 ,a key enables the current to be shut off or on without removal of the conductors4 ,dirt is a non-conductor of electricity1 and the studs of the dial must be kept clean with emery paper or plate-powder1 as also the under surface of the needle1 key1 and binding screws1 which unscrew to admit of removal4 ,in the daily use of a battery the chief work is usually thrown upon the first half 7say in a battery of forty cells1 upon the first twenty-five71 and various arrangements have been added to batteries by ingenious instrument-makers to enable the operator to vary his selection of the cells to be brought into use1 and thus to relieve the first half of his battery1 or1 in other words1 to equalize its work4 ,but this unequal work question is more a theoretical than a practical evil2 for if the initial cells grow weaker a greater number can be placed in use4 ,i have carefully studied all the proposed modifications1 and have found in all of them the remedy worse than the disease1 unless the graduating dial be doubled 7an original suggestion of my own71 so that the initial cells of one week may be made the terminal cells of the next4 ,illustration3 ,,fig4 #g4 ,graduating dial with needle at 8#j04 ,when desired batteries can be constructed with this double dial 7,fig4 #h71 but it adds to the complexity of the instrument1 and ,i do not myself use it4 ,illustration3 ,,fig4 #h4 ,new form of ,graduating ,dial4 ,in ,fig4 #i a similar battery is shown to that just described2 but the elements consist of carbon and zinc1 and are lifted into and out of a bichromate solution4 ,as it can be recharged by the owner without the necessity of sending it to the maker1 it is especially suited for country and colonial practitioners4 ,illustration3 ,,fig4 #i4 #dj-;,cell ,voltaic ,battery with zinc and carbon elements1 and lifting apparatus4 ,,sn3 ,essentials of a ,medical ,voltaic ,battery4 ,to recapitulate4 ,the essentials of a medical ,voltaic battery are-- a4 ,a constant supply of electricity of sufficient quantity and quality4 b4 ,a means by which this electricity may be administered in measured doses4 c4 ,a means by which the direction of its current may be changed4 d4 ,a means by which it may be instantly discontinued4 ,,faradism4 ,,sn3 ,the ,faradaic ,current4 ,the ,faradaic1 induced1 interrupted1 or electro-magnetic current1 is the third form of electricity employed in medicine4 ,faraday1 as you will recollect1 discovered1 that if two metallic wires were so fixed as to be parallel and close to each other1 but not to touch2 and that if then a current of ,voltaic electricity were sent along the first wire1 another current appeared in the second4 ,this secondary or induced current1 as it is called in contradistinction to the current1 the primary or inducing current sent along the first wire is only momentary1 but it appears again for a moment when the first current ceases1 but in a reverse direction4 ,it is most convenient to wind these two wires round two reels1 so as to form separate coils1 and to place the primary within the secondary coil4 ,each single turn of the primary then acts not only on the parallel turn of the secondary wire1 but on all the turns near it1 and the power of such an apparatus is much greater than that which would be obtained by the same lengths of wire running side by side in a straight line4 ,our two coils being thus arranged1 we pass through our primary wire a succession of electrical currents1 and in practice this is accomplished by connecting its extremities with a battery supplying a continuous current1 which by an ingenious mechanism we frequently break or interrupt4 ,illustration3 ,,fig4 #aj4 ,faradaic ,battery4 ,a4 ,cells shown by the removal of the compartment4 ,b4 ,for conductors and accessories4 ,d4 ,screw regulating the pressure of a spring which modifies the vibration of the hammer1 ,e4 ,e4 ,hammer vibrating between the electro-magnet1 ,f1 and the point of a platinized needle regulated by the screw1 ,g4 ,f4 ,bundle of iron wires rendered an electro-magnet by the passage of the ,voltaic current from the cells1 ,a1 through the primary coil1 ,k1 within which this bundle of wires is inserted4 ,g4 ,screw regulating position of a platinized needle4 ,h4 ,the graduator1 a stem to which is attached the movable secondary coil1 ,l4 ,the front part of the case has been cut away in the engraving1 to show the construction of the induction apparatus4 ,i1 ,i4 ,binding screws for attachment of the conducting wires1 c4 ,k4 ,the primary coil1 fixed upon a pedestal4 ,in the figure1 the secondary coil1 ,l1 is wholly withdrawn from the action of the primary1 and its strength of current depending entirely upon the extent to which it covers the primary1 it is evident that the height which the graduator1 ,h1 stands above the element board will exactly indicate this strength4 ,l4 ,movable secondary coil4 ,m1 ,m4 ,binding screws for attachment of the pedal rheotome1 ,n1 for slow interruption4 ,these interruptions are made by the pressure of the operator's foot upon the spring1 ,p1 but in practice they are very seldom wanted1 and the fittings are only added to the instrument when specially ordered4 ,o4 ,a spring retaining the secondary coil1 ,l1 in any desired position4 ,,sn3 ,the ,faradaic ,battery4 ,the ,faradaic ,battery4--,in ,fig4 #aj 7see p4 #bi71 a ,faradaic battery1 worked by two ,leclanch cells1 is shown2 but ,i find it better to employ either one or two ordinary bichromate cells instead of the ,leclanch1 as the former can be kept in order by the operator himself without much trouble4 ,the primary coil is fixed upon a pedestal1 the secondary is movable1 and can be lifted over or thrust away from the primary4 ,the degree of action in the secondary coil being proportionate to the extent to which it is brought under the influence of the primary1 this arrangement admits of the most perfect graduation of the current2 and it has been for some time in use in all well-constructed instruments4 ,the innovation ,i have made consists in limiting the primary coil to its legitimate purpose of induction1 and rendering the secondary alone available for application to a patient4 ,i have been long satisfied that therapeutically the distinction between the primary and secondary coil entirely consists in the greater tension of the current of the secondary coil enabling it to penetrate easily several thicknesses of muscle1 but there is no therapeutic indication that cannot be fulfilled by this secondary coil2 and at its lowest power ,i have frequently applied it to the conjunctiva4 ,the rapidity of vibration of the interrupting hammer is varied by increasing or decreasing the distance between the point of the needle and the electro-magnet by the protrusion or retraction of the screw1 of which the needle forms the end--that is1 by increasing or decreasing the space through which the hammer passes in its vibration1 and also by altering the pressure of its spring1 but there is seldom therapeutic need for change of vibration2 and unless this exists it is better not to alter the adjustment so long as the instrument acts well4#i ,after considerable use the point of the needle1 and the exact spot of the platinum disk of the hammer against which this needle impinges1 become oxidized1 causing weakening or stoppage of the current4 ,this platinum disk has been constructed to rotate1 and a hole has been drilled in its circumference 7,fig4 #aa74 ,by inserting a little lever furnished with the instrument into this hole1 the slightest twist given to the disk is sufficient to bring a new surface of platinum into contact with the needle point4 ,this will usually be all that is required1 but1 if not1 the needle can be unscrewed1 and its point cleaned with emery paper4 ,when in course of time the disk becomes dotted over with spots of oxidation1 the screw fixing the hammer in position must be unscrewed1 the hammer lifted out1 and its surface similarly cleaned4 ,illustration3 ,,fig4 #aa4 ,the ,platinum ,disk and ,lever4 ,induction currents are also produced in coils of wire by the action upon them under certain conditions of a permanent magnet--as in the ordinary rotary magneto-electric machine--but these machines may be discarded from our consideration1 for they are uncertain in action1 painful in application1 and do not admit of exact graduation4 ,an apparatus in which both currents are combined is extremely convenient if it is so constructed that either the ,voltaic or ,faradaic current can be brought to the same terminals1 thus avoiding the trouble of changing the conductors--a point of the greatest possible convenience when examining patients for diagnostic purposes by both forms of electricity1 either in succession or alternately4 ,,sn3 ,the ,hospital ,combined ,battery4 ,in the ,hospital ,combined ,battery 7see ,fig4 #ab71 constructed from my designs1 the two currents are thus united1 and its details are precisely similar to those of the separate batteries1 with the exception of the ,dial being furnished with an additional stud lettered ,coil4 ,when the needle points to this stud the current from the ,faradaic coil is brought into action2 when it points to the numbered studs1 the cells numbered thereon as in my ,voltaic instrument1 and when it points to 8#j10 both currents are shut off4 ,illustration3 ,,fig4 #ab4 ,hospital ,combined ,battery4 ,a4 ,guard block4 ,k4 ,tray for holding accessories4 ,e4 ,dial plate4 ,c4 ,bolt securing element board4 ,g4 ,key for interrupting current4 ,m4 ,hammer4 ,f4 ,commutator of the poles4 ,i1 ,i4 ,binding screws for conducting wires4 ,l1 ,l4 ,hinges of element board4 ,h4 ,graduator of coil4 ,n4 ,electro-magnet4 ,r4 ,screw regulating position of needle4 ,d4 ,screw regulating spring of hammer4 ,other instruments1 such as those of ,sthrer and ,weiss1 are excellent1 and were unsurpassed until the invention and improvement of the ,leclanch and other cells4 ,but ,i might talk upon instruments for hours without exhausting the list2 and ,i have felt obliged to limit myself to a description of those ,i believe best fitted to our requirements2 but it1 of course1 must be understood that my further observations will apply equally to currents of electricity furnished by any properly constructed and reliable apparatus4 ,,sn3 ,accessories of the ,battery4 ,we have now brought the electricity to the terminals of our battery1 and we must next consider the best means of conveying it to the sponges1 conductors1 or1 as they are generally termed1 rheophores or current carriers1 by which it is finally applied to our patient4 ,,sn3 ,conducting ,cords4 ,our first necessary accessory is a conducting cord or wire1 and it is of the first importance that this should really be what it is called--8a conductor0--for any fault or break of connection in it will1 of course1 nullify the best and most perfect battery4 ,it must also be sufficiently pliable1 and be insulated by being coated with some non-conducting material that the electricity may not escape from it to any conducting substance with which it may accidentally come into contact4 ,the conducting cords sold by instrument-makers are sometimes not insulated at all1 and then they are quite useless1 but they are more commonly composed of several strands of metallic wire of about the diameter of sewing thread1 the whole enclosed in some silken or woollen material1 and nothing can be better than these latter when quite new4 ,their disadvantages are that they become frayed after a little use1 and are liable to be constantly out of order1 causing interruptions in the current1 while they will only fit one kind of machine4 ,i have had endless trouble with them2 and for some years ,i have used nothing but thin copper wire1 coated with gutta percha in the same way as that known as 8telegraph wire40 ,this is perfectly insulated1 sufficiently pliable for all practical purposes2 it is cheap1 and can be made to fit any sort of connection4 ,its one disadvantage is1 that it is liable to break at the point where it is received into the terminals of the battery1 or the screw socket of the rheophore4 ,should this happen1 all that is necessary is to scrape off the gutta percha coating with a pocket knife for an inch from the broken end1 by which we get practically a new conducting cord4 ,we have now considered fully the birth and parentage of medical electricity1 and we have conducted it to within almost a hair's breadth of our patient4 ,the various methods of applying it will be considered in our next ,lecture1 which ,i trust1 ,gentlemen1 to render more interesting2 but the dry details we have been discussing are1 ,i assure you1 essential as a secure foundation for a practically useful survey of electro-therapeutics4 ,,footnotes3 #a ,see 8,vital ,motion as a ,mode of ,physical ,motion40 ,by ,c4 ,b4 ,radcliffe1 ,m4,d4 ,macmillan4 #b ,see ,mr4 ,netten ,radcliffe upon the differential reaction of voltaic and induced currents of electricity4 ,note to page #cca1 vol4 i41 of ,bazire's translation of ,trousseau's 8,clinical ,medicine40 ,hardwicke4 #c ,this observation1 made in #ahgc1 requires some qualification now 7#ahhf74 ,at several of the great medical schools1 though not at all1 electrical treatment has been transferred from the hospital porter to some member of the hospital staff2 and at more than one a systematic course of lectures upon electro-therapeutics has been delivered4 #d ,i speak feelingly upon this matter1 for from an early period of my electrical experience ,i have suffered much from batteries--from instruments 8striking work0 at the most inconvenient moment--from spilling of corrosive acid upon fingers and clothing1 to the detriment of both1 and of temper too1 ,i fear4 #e ,so long ago as #ahgj1 ,i was in the habit 7at the suggestion of ,dr4 ,radcliffe7 of employing at an ,institution for ,resident ,patients1 a method of 8charging0 a patient which ,i believe to be unique4 ,,sn3 ,unique method of charging a patient4 ,during dry summer weather the patient reclined upon a couch in the gardens insulated by glass supports1 and a sort of lightning conductor was improvised by attaching a #cj-;feet salmon-rod to the foot of the couch1 a piece of ordinary 8telegraph wire0 being carried up the rod1 its insulation being removed from about a foot which projected above the top of the rod4 ,upon a fairly warm and dry day the patient became 8charged0 and sparks could be drawn from him as from a patient in ordinary connection with a ,franklinic machine in rotation4 ,upon more than one occasion in those ancient ,static days1 an attempt was made to insulate a patient for a whole night1 and to maintain the charge by a relay of 8rotating nurses20 but the human machines failed1 and suitable gas engines were not then available2 hence the procedure related above was1 if conducted for three or four hours on a dry summer afternoon1 a by no means bad substitute for a close room and a rotating ,static machine4 ,in ,new ,york1 in winter1 when the rooms are covered with thick carpets1 and when the atmosphere is dry1 it has been known that on shaking hands with a visitor1 not only has the 8shock10 which under similar circumstances occasionally occurs in ,england1 been felt1 but that a spark has passed2 and children have been known to slide over the carpet towards each other and exchange sparks by way of sport4 ,the influence of atmospheric and other ordinary electrical conditions has been far too little studied by electro-therapeutists4 #f ,the ,carr ,machine can be obtained from ,mr4 ,groves1 #hi ,bolsover ,street2 the ,fly ,wheel from ,messrs4 ,hovenden and ,co41 ,great ,marlborough ,street2 and the ,gas ,engine from ,messrs4 ,andrew and ,co41 ,engineers1 ,stockport4 #g ,currents of electricity from large fixed batteries are most marked in their curative effects2 but patients are not always movable6 #h ,the ,galvanometer as an aid to the ,dosage of ,electricity4--,the dose of voltaic electricity is made up of two factors1 7a7 the strength of the current and 7b71 the time during which it is applied to the patient4 ,,sn3 ,the ,galvanometer as an aid to the ,dosage of ,electricity4 ,the strength of the current is directly dependent upon the number of cells employed1 but1 unfortunately1 cells of dissimilar construction evolve currents of very unequal strength2 while cells that have been freshly charged are more powerful than similar ones that have been partly exhausted by use2 and1 therefore1 to speak of a current from 8so many cells10 though1 practically1 a convenient method of dosage1 fails to convey any exact idea of a measured and unvarying quantity4 ,it is a comforting theory to electro-therapeutists that a galvanometer will enable them to administer their doses of electricity with as much exactitude as we daily prescribe so many grains1 or so many minims of ordinary medicines2 but1 like some other theories which save us much trouble1 when adopted as theories only1 it fails us in practice 7at least according to my experience71 and chiefly so1 because a galvanometer can be usefully employed only when it is included in the circuit of a continuous current1 as1 e4g41 in aneurismal electro-puncture2 and1 ,i believe1 ,i am within the mark in saying that electrizations1 which even admit of its useful employment1 are indicated in barely #e per cent4 of ordinary cases in electro-therapeutics2 and that it is of no practical utility1 where we most want aid1 in measuring1 not the current which leaves the battery terminals1 but that which1 after overcoming the very variable resistance of the human skin1 really reaches the underlying muscular and nervous tissues1 which1 in #ie per cent4 of our cases1 we desire to influence1 not by a constant1 but by an interrupted ,voltaic current2 and the amount which really reaches these tissues depends largely upon the condition of the patient's skin1 and1 ,i may also add1 upon the kind and shape of the conductor1 and its degree of moisture1 c42 and the operator will do well to graduate his dose of electricity by a consideration only of the three factors1 number of cells1 effect upon himself1 and effect upon his patient1 discarding entirely the use of any merely mechanical aids to graduation4 ,i am induced to speak thus strongly because men of scientific reputation have advocated the habitual use of the galvanometer1 not alone by medical men trained to precision of observation1 but by private patients as 8enabling them to carry on the treatment at home with all the accuracy desirable60 ,the prospect of the ordinary patient provided with a battery1 the use of which he is complicating by a galvanometer1 is anything but reassuring to those physicians who not only prescribe electricity1 but are themselves habituated in applying it--which1 by the way1 is a very different thing--and who have had frequent experience of the manner in which patients misunderstand1 or fail in correctly carrying out1 the most explicit directions4 ,electricity will be left in the hands of specialists1 and necessarily do but a tithe of the good it is capable of affecting1 until the mass of the profession can be induced to master the few preliminary details essential to its successful application1 and ,i fear that the suggestions that have been made--suggestions which ,i believe to be entirely without foundation--that there exist practical difficulties to its dosage1 will tend to postpone rather than to accelerate its more extended use4 ,should any of you desire to use a galvanometer1 that patented by ,sprague1 of ,birmingham1 is the one most adapted for use in medicine4 ,electricity is a force1 and as with other forces it has its standard of measurement4 ,in mechanics we know that the power sufficient to raise one pound to the height of one foot is the basis of measurement4 ,similarly in electricity the unit of measurement is the force which will raise one gramme to the height of one metre1 and the standard multiple of this was called a 8,british ,association ,unit10 or shortly1 a 8,b4,a40 unit1 and it is now called an 8,ohm0 when used to measure the resistance offered to the current1 and a 8,veber0 when used to measure the strength of the current itself4 ,the ordinary galvanometer is founded on the principle that a magnetic compass needle has a tendency to place itself at right angles to a current of electricity1 and the degree to which the needle is deflected is a measure of the quantity of electricity1 but the angle of deflection is not proportionate to the current strength1 and it differs in different galvanometers2 but in 8,sprague's ,galvanometer0 the dial is divided1 not into degrees1 but into divisions of thousandths of ,vebers--divisions which were obtained by noting the deflections given by the needle with currents of known strength4 ,i am indebted to ,mr4 ,sprague for his courtesy in endeavouring to so modify his galvanometer as to render it available as a graduator of doses of interrupted ,voltaic electricity1 but although he has not succeeded in doing this1 he has constructed for me an instrument which1 supposing that a battery be partially exhausted1 will indicate with precision the absolute strength of1 say1 twelve of its cells as compared with twelve newly-charged cells1 and also the condition of each individual cell1 points often of much practical convenience in an ,hospital ,electrical ,room4 #i ,a little care is needed to regulate the vibrating needle4 ,the spring should but barely touch the hammer1 the adjustment being almost entirely regulated by the protrusion or retraction of the needle by the action of its screw2 and the slightest twist of this screw will be sufficient4 ,when the vibration is uneven or stops1 and careful manipulation of the needle fails to re-establish it1 remove the needle and clean its point as directed in the text4 ,,lecture ,,ii4 ,,methods ,,of ,,applying ,,electricity4 ,,gentlemen1 ,,sn3 ,rsum of ,first ,lecture4 ,in our first ,lecture we studied the different kinds of electricity employed in medicine1 and the construction and management of batteries4 ,i reminded you that we made use of three kinds of electricity2 firstly1 of friction or static electricity1 ,franklinism2 secondly1 of the electricity of chemical action1 ,voltaism1 or ,galvanism2 and1 thirdly1 of induced electricity1 ,faradism3--that there had been certain difficulties in the employment of ,franklinism1 but that these difficulties no longer existed2 that ,voltaic electricity was electricity in motion1 or current electricity1 but that while its current 7unless artificially interrupted7 was always continuous--flowing1 that is1 in an unbroken stream--and from the positive to the negative pole1 until the battery was exhausted--it by no means followed that it was constant1 that is1 that it did not vary appreciably in power during application2 that only batteries supplying a fairly constant current were fitted for medical use1 and that all others should be rejected4 ,we then considered different batteries1 both fixed and portable2 that while large fixed low tension batteries were unquestionably superior in their therapeutic effects1 patients unfortunately were not always movable1 and that a portable battery became1 therefore1 a sine qu non2 that portable batteries might be conveniently divided into two classes1 one in which electricity was generated by the elements being immersed in an exciting fluid only during actual use1 and being taken out of the fluid immediately after use2 and the second that in which no removal of the elements was necessary2 that the ,voltaic current was graduated into doses by some arrangement determining the number of cells to be employed in each case1 but that this method1 while practically useful and sufficient1 failed to convey an exact idea of a measured and unvarying quantity of electricity2 and that it had been contended that by the use of a galvanometer1 doses of electricity might be as accurately administered as so many grains or minims of ordinary medicines1 but that1 perfect as the theory might be1 ,i had personally failed to obtain help in practice from a galvanometer2 that next in importance to a method of dosage1 was it to be able to instantly change the direction of the current1 or to at once turn it 8off0 or 8on10 in addition1 of course1 to the fundamental requisite of a continuous supply of electricity of sufficient quality and quantity4 ,we next considered the induced or ,faradaic current1 so-called1 which ,i reminded you is not a current at all1 but a rapid discharge or succession of those momentary shocks1 each perfectly distinct in itself1 and separated by an appreciable interval of time from its fellows1 which ,faraday discovered to be generated or induced by a ,voltaic current flowing along a wire in other wires parallel to1 but separated from1 the first wire2 that by winding the two wires upon two movable reels and introducing one within the other1 not only might these secondary currents be multiplied indefinitely in proportion to the number of spirals of wire1 but by introducing or withdrawing the one from within the other an exact method of graduation was afforded us4 ,i pointed out to you that there was no therapeutic distinction between the so-called primary and secondary currents1 and ,i recommended you therefore to use only the currents of the secondary coil4 ,i then showed you the construction of ,faradaic instruments1 and of instruments combining both ,voltaic and ,faradaic currents1 and our survey was completed by a consideration of the different varieties of conducting wires or cords1 and my recommendation of thin gutta-percha covered copper wire as generally superior to any other form4 ,we have to-day to study methods of applying electricity1 and to learn how to use the instruments1 with the construction and properties1 of which ,i trust you are now familiar2 and1 ,gentlemen1 it is well worth your while to have obtained this knowledge1 for its possession will not only enable you to readily rectify any faults in the working of your batteries1 but the necessity of sending them to the instrument-maker may be often avoided4 ,we have already studied methods of applying ,franklinism4#aj ,voltaization and ,faradization may both be applied either generally--as in the different forms of electrical baths--or locally4 ,,sn3 ,the ,application of ,electricity4 ,a convenient method of applying electricity1 when very strict localization is not required1 is to insert the feet and hands of the patient1 or one foot and one hand1 as the case may be1 in separate vessels containing tepid salt and water with which the conducting wires of the battery are in contact1 the current being allowed to circulate during the time required4 ,ordinary foot-pails1 basins1 or jugs1 will fulfil every requirement2 while thick telegraph wire answers well to connect the battery with the vessels of water1 as it is little liable to break and wears well4 ,a variety of the constant current 7originated by ,dr4 ,radcliffe7 is very readily applied in the way just described1 with the addition only of some means of insulating the patient and the accessories1 and of a length of ordinary uninsulated copper wire4 ,,sn3 ,radcliffe's ,positive ,charge4 ,dr4 ,radcliffe believes that an administration of positive ,voltaic electricity1 somewhat analogous to the charge of ,franklinic electricity1 is frequently beneficial4 ,he insulates the patient and the accessories1 and having connected the negative pole with the earth by a wire which he calls a 8ground-wire10 he allows the current to pass4 ,with careful insulation the negative electricity passes away by the wire1 and while the current circulates the patient continues 8charged0 with positive electricity4 ,there must be two wires from the negative pole1 one to be applied1 as well as the positive1 to the patient1 and the other taken 8to earth40 ,this latter may be conveniently attached to a chandelier or gas-pipe1 which always gives a direct metallic conduction to the ground4 ,a perforated vulcanized indiarubber mat1 or a sheet of gutta percha1 or a glass-legged stool can be employed to insulate the patient and the accessories4 ,,sn3 ,the ,electric ,bath4 ,there is another generalized application which has been much advocated1 and remarkable statements have been put forth1 not only of its curative power in almost every disease1 but also of its purely physical and chemical effects--,i refer to that by 8,electric ,baths10 several establishments of which exist in ,london1 but you need not send your patients to them4 ,you can teach them how to take an electric bath in their own bed or bath-room4 ,a bath sufficiently large for the patient to recline in it should be insulated by glass supports 7four stout tumblers will do very well71 and filled with water at a temperature of #ie to #ajj degrees4 ,a metallic plate in connection with one pole may be inserted at the head1 and a second plate in connection with the other pole at the foot of the bath4 ,the patient should be protected from direct contact with either plate by sitting upon a wooden framework4 ,with a sufficiently powerful current1 a portion of the electricity will pass through the body of the patient reclining thus between the poles4 ,another method is to connect the water with one pole1 and for the patient to grasp in his unimmersed hands a copper bar covered with wet flannel1 and in connection with the second pole of the battery2 or a conductor from this second pole may be held almost1 but not quite1 in contact with any part of the body immersed in the water4 ,either the ,voltaic or ,faradaic current may be used4 ,ordinary water with the ,faradaic current1 but salt and water1 or acidulated water1 with the ,voltaic4 ,,sn3 ,general ,faradization4 ,another more generalized application is that introduced by ,beard and ,rockwell1 under the name of 8,general ,faradization40 ,the patient sits with his naked feet upon a sheet of copper connected with one pole1 while the other pole is connected by a moistened sponge with the left hand of the operator1 who passes his disengaged hand1 slightly moistened1 over the muscles of the patient1 and sometimes over his whole body4 ,the current1 ,i need hardly say1 passes through the body of the operator before it reaches the patient1 and the sensation he feels is his chief guide to its graduation4 ,,sn3 ,centralized ,galvanization4 ,another general application is the 8,centralized ,galvanization0 of the same authors1 in which their object is to bring the whole central nervous system under the influence of the ,voltaic current4 ,they place one pole--usually the negative--at the epigastrium and pass a large moistened sponge from the positive pole over the forehead and top of the head1 along the inner border of the sterno-mastoid1 from the stylo-mastoid fossa to the sternum1 and down the entire length of the spine1 from the nape of the neck to the sacrum4 ,the brain1 sympathetic and spinal cord1 and the pneumogastric nerves are thus submitted to the influence of the current4 ,,sn3 ,localized ,electrization4 ,but the great majority of cases require--not a generalized1 but a strictly localized application1 and for the fundamental principles of all methods of localized electrization we are indebted to the late ,dr4 ,duchenne 7the 8father of electro-therapeutics071 for before him no one had attempted any local application of electricity that could properly be so called4 ,indeed1 to ,duchenne may be fairly ascribed the very birth of medical electricity as a branch of therapeutics1 and in the true and kindly words of the ,lancet1 when announcing his death3--8,no field of work was ever seized upon with more eagerness2 ever cultivated with more earnestness2 or perhaps ever made to yield a better harvest than that which the discovery of induced electricity placed at the disposal of the man whose genius was the first to recognize1 and his talents to secure1 the opportunity it afforded4 ,taking his work at its lowest estimate1 he was a man to whom medical science owes a large debt of gratitude1 and whose memory deserves a warm tribute of regard40 ,duchenne's two test experiments1 demonstrating the fundamental principles of his method1 ,i will now repeat upon the posterior surface of my left forearm4 ,i propose to arrest ,faradism in the skin1 without allowing it to stimulate the subjacent muscles4 ,to do this it is necessary for the skin to be quite dry--moisture1 as you know1 being a conductor of electricity--and to make sure of sufficient dryness1 ,i sprinkle the skin with a little starch powder4 ,i now apply to the dry skin the dry metallic conductors of an induction instrument in action4 ,i am afraid you cannot see1 ,gentlemen1 the small sparks produced as the two electricities combine upon the cutaneous surface1 or hear the slight crackling sound produced1 but you observe no muscular contraction1 and what ,i feel is a superficial and evidently cutaneous sensation4 ,i now replace the dry conductors by well-moistened sponges4 ,you observe that ,i have not altered the power of the current1 but that there is energetic contraction of the extensor muscles4 ,this is quite involuntary1 and is due to the electric irritation of the branches of the motor nerves4 ,it follows from these experiments that we may1 at pleasure1 arrest electricity in the skin1 and that without puncture or incision we may make the current traverse the skin1 and concentrate its action upon subcutaneous organs4 ,it was at one time objected that the muscular contraction was the result--not of irritation limited to the muscle or its motor nerves--but of reflex action2 but ,duchenne demolished this objection by a vivisection4 ,having removed the skin from the face of a living rabbit--to whom chloroform had been administered--he divided the facial nerve of one side only1 in order that the muscles supplied by it might be cut off from all connection with the cord4 ,he then applied electric excitation to each muscle of the face1 alternately1 on the two sides4 ,the muscles contracted separately and equally on both sides4 ,he then destroyed the brain of the same animal1 in order to place the cord in a condition favourable to the production of reflex action1 and again excited the muscles as before4 ,the results were absolutely the same4#aa ,muscular electrization may be produced either--as ,i have just shown you--by placing the conductors upon the muscle itself1 a procedure termed direct or intra-muscular electrization1 or by exciting only the motor nerve trunk1 which is termed indirect1 or extra-muscular electrization1 and which we shall consider presently4 ,illustration3 ,,fig4 #ac4 ,cylindrical ,sponge-holder4 ,,sn3 ,different kinds of ,rheophores4 ,for direct excitation of the larger muscles it is convenient to use well-moistened sponges1 contained in cylinders of different sizes1 or metallic disks1 covered with wet leather and having conveniently shaped handles4 ,a useful size of cylinder is one such as this 7see ,fig4 #ac71 having a depth of about #a-a_/b by #a-a_/h inches1 which allows the sponge to fairly fill it1 while in such forms as this--#f inches by #a--when the sponge is inserted the lower three-fourths of the cylinder is empty1 and the conduction of the current liable to become imperfect4 ,such a cylinder as this1 without any insulating handle at all1 is worse than useless1 and is a still persisting relic of the barbarous time when the patient was invariably electrized by causing him to hold the conductors one in each hand1 a proceeding extremely dangerous in certain pathological conditions1 and in other cases not likely to be of benefit to him4 ,the insulating handles should be well hollowed out1 that they may be used1 lying comfortably between the fingers1 when holding two in the same hand4 ,the disk rheophore 7see ,fig4 #ad71 a metallic button covered with wash-leather1 is extremely useful2 it has the advantage over the sponge of allowing firm pressure to be made without the inconvenience of water being squeezed out1 while by using its edge it may be made to answer in the majority of cases for a pointed conductor1 which is fitted chiefly for application to very small muscles1 such as the interossei and some of those of the face4 ,the wire is attached to the conductor by being screwed into the socket 7see a1 ,fig4 #ad74 ,a conducting cord is very apt to get frayed at the point of juncture1 and that the wire which ,i recommend is not open to this objection is not the least of its advantages4 ,,sn3 ,direct ,electrization4 ,in direct electrization the rheophores should be firmly pressed down upon all points of the surface of the muscle1 that all of its fasciculi may be equally electrized4 ,with the ,faradaic current it is convenient to apply the rheophores1 held in the same hand 7see ,fig4 #ae71 for from twenty to thirty seconds1 to every part of the surface of the muscle1 or group of muscles1 promenading them as nearly as may be in lines from the origin to the insertion of the muscles4 ,if the rheophores are not held in the same hand care should be taken to keep them near to one another1 for the tension or penetrating power of ,faradism is so great1 that without this precaution there will be liability to excite reflex action4 ,with the interrupted ,voltaic current this liability does not exist1 and a better plan when using it is to hold the sponge from the positive pole stationary1 near to the origin of the muscles1 and to stroke or paint as it were the entire muscular surface with the sponge from the negative pole1 gliding it in lines from the position of the positive4 ,in using the constant ,voltaic current both sponges must be held quite immovable1 and so applied it differs altogether in its effects from the very same strength of current interrupted by moving the conductors4 ,i will demonstrate these different applications upon the extensors of my left wrist and fingers--,faradism--,voltaism--,constant ,current4 ,illustration3 ,,fig4 #ad4 ,metallic ,disk1 covered with ,wash-leather4 ,illustration3 ,,fig4 #ae4 ,method of holding ,sponge-holders with ,sponges inserted4 ,,sn3 ,indirect ,electrization4 ,indirect1 or extra-muscular electrization1 next claims our attention4 ,you will recollect that it is produced by acting upon the special nerve trunk and its branches1 instead of by placing the rheophores upon the muscle itself4 ,we may thus call a motor nerve into action without affecting the cutaneous nerves1 and with a minimum of power of current1 and necessarily a minimum of sensation which hardly ever need amount to actual pain4 ,this method is preferable1 therefore1 in cases where we desire to produce muscular contraction and as little sensation as may be1 and again when the sedative influence of the constant ,voltaic current is required to be localized in any special nerve4 ,in its application it is convenient to place a good-sized sponge connected with one pole upon an indifferent part of the body1 such as the sternum1 and to apply a pointed conductor from the second pole directly over the course of the nerve it is desired to act upon4 ,speaking generally1 these motor points as they are called may be selected by reference to a good anatomical plate1 but only approximately1 for we know that it is common to find variations in the course of the nerves and in the mode of their distribution among the muscles1 and this being so1 it is well when we propose to act upon a motor or mixed nerve 7which is not paralyzed71 to make sure that we are localizing the current in it by producing for a moment the contraction of its muscles and then marking the spot by touching it with a pencil of nitrate of silver4 ,this1 of course1 is only necessary where in our subsequent electrization we do not wish muscular contraction1 as in the treatment of neuralgia4#ab ,i will demonstrate indirect electrization by ,faradizing the median nerve in my left forearm above the wrist1 and before it passes beneath the annular ligament of the carpus4 ,it lies a little below the surface1 between the tendons of the flexor carpi radialis and palmaris longus4 ,you observe that its muscles powerfully contract and oppose the thumb to the other fingers1 at the same time abducting it4 ,there occurs also a slight flexure of the first phalanges of the index and middle fingers4 ,professor ,ziemssen in his work on ,medical ,electricity has published some extremely accurate plates of the motor points of the body1 and ,i have grouped together the more important of them in a chart or map for convenient reference4#ac ,ziemssen's method of procedure was to find out experimentally the points where the application of electricity most readily produced muscular contraction4 ,he then marked these points with coloured chalk1 and after a sufficient number of trials with nitrate of silver4 ,photographs of the parts thus marked were taken and afterwards transferred to the wood blocks4 ,these figures may therefore claim to be true to ,nature1 although they may not be absolutely correct for every individual4 ,ziemssen verified their approximate exactitude by following the course of the nerves very accurately in the dissecting-room and observing their points of entrance into1 and their course within1 their muscles1 with constant reference to the surface of the body2 but he was not completely satisfied until he had determined the motor points upon the skin immediately after death1 and before the reaction to electricity had disappeared1 and submitted these points to the scalpel4 ,the results of the three methods coincided perfectly4 ,,sn3 ,cutaneous ,electrization4 ,we will next consider cutaneous electrization4 ,i have already shown you that when the skin and the conductors are both quite dry1 a ,faradaic current of moderate power 7and practically this form of electricity is always employed in cutaneous electrization7 does not penetrate the skin1 but is localized upon its surface4 ,there are three methods of applying cutaneous ,faradization--the method that we employed--that of 8,metallic ,conductors20 the 8,electric ,hand10 as it is called1 in which the operator having applied one conductor to some little sensitive part of the patient's body1 holds the second in his left1 and passes the back of his right hand over the points he wishes to excite1 these points of the patient's skin and the back of his hand being dry1 and sprinkled with absorbent powder2 and the 8,wire ,brush10 a brush of metallic wire1 which replaces one of the conductors1 and which is moved over the skin4 ,with a strong ,faradaic current this wire brush becomes the most powerful of all the excitants of the skin which do not disorganize its structure2 in fact it was proposed by some scientific parliamentary philanthropist as a substitute for flogging in the navy1 and ,i have no doubt that more intense pain may be produced by it than by any application of the cat1 however well laid on6 ,,sn3 ,electrization of ,internal ,organs4 ,the methods of electrizing internal organs need not detain us long4 ,the rectum and muscles of the anus may be electrized by introducing into the rectum the rectal rheophore1 a metallic stem insulated by gum elastic1 and moving it over the internal surface1 bringing it also into contact with the levator and sphincter ani4 ,a well-moistened sponge connected with the other pole may be applied to the abdominal muscles or to the neighbourhood of the anus4 ,the rectum must be first freed from fcal matter4 ,the bladder is most readily electrized by the introduction into the rectum of the rectal rheophore1 and into the bladder--previously emptied--of a curved metallic sound insulated by an elastic catheter to within an inch of its vesical extremity4 ,this sound must be brought into contact successively with all points of the neck of the bladder4 ,the uterus by the introduction of the rectal rheophore1 connected with one pole1 to the os uteri1 and by the application of two sponges from the other pole1 one to the abdominal parietes1 the other to the lumbar region4 ,the larynx1 externally by one sponge to the nape of the neck1 and the second to the exterior of the larynx2 or1 internally1 a sponge to the neck as before1 and the introduction by the aid of the laryngoscope of a small bit of sponge at the end of a curved metallic stem1 insulated by a gum-elastic catheter1 the current not being allowed to pass until it is seen by the laryngeal mirror that the sponge is in the desired position4 ,the male genital organs by moist rheophores to the scrotum over the testicle2 but if it be desired to excite the vesicul seminales1 the bowel is first emptied1 the rectal rheophore is then introduced and so directed that its olive-shaped termination may be brought into relation with the vesicul4 ,for this purpose it is sufficient to move the rheophore from right to left and vice vers4 ,a powerful current will penetrate the intestine and reach the vesicul1 exciting them energetically4 ,the circuit is completed by a second rheophore placed on an unsensitive part of the body4 ,,sn3 ,electrization of the ,central ,organs4 ,in electrization of the central organs of the nervous system1 the ,voltaic current is alone used1 and in its application to the brain1 the sympathetic nerves1 or the organs of the senses1 especial circumspection must be employed4 ,as a general rule it should not be had recourse to when central excitement is contra-indicated1 and in all cases the minimum dose should be commenced with1 and the application discontinued upon the occurrence of giddiness1 nausea1 or cerebral symptoms4 ,with these precautions the brain may be electrized by well-moistened sponges applied to each mastoid process1 to each temple1 or to the frontal and occipital protuberances4 ,the sponges must be held immovable4 ,to galvanize the superior cervical ganglion of the sympathetic1 one electrode of small size must be deeply pressed into the auriculo-maxillary fossa1 and the other with a good-sized sponge applied over the sixth or seventh cervical vertebra1 or to the manubrium sterni1 close to the border of the sterno-mastoid4 ,the spinal cord may be electrized by keeping one sponge1 usually the positive1 stationary1 and moving the other up and down by the sides of the vertebr1 or one pole may be applied to the spine1 and the other held to a nerve or muscle4 ,the retina by a moistened conductor to the closed eye1 and the second to the temple or to the mastoid process of the same side4 ,the auditory nerve by one conductor tipped with sponge and inserted to the bottom of the meatus1 the second being held in the hand of the opposite side2 or the meatus may be filled with tepid water1 and a metallic wire traversing the axis of a vulcanite tube may be immersed in the water1 the second conductor being a well-moistened sponge to the nape of the neck4 ,direct application to the ocular muscles or to the conjunctiva is usually inadmissible1 but one pole may be placed over the facial nerve below the ear1 and the other applied to the closed eyelid1 or the operator may use the forefinger of his right hand1 covered by a finger-stall of wet linen as an electrode1 passing the current through his own body by holding a moistened sponge from one pole in his left hand1 the conductor from the second pole being similarly held in one of the hands of the patient4 ,this application is not only convenient1 but it is calculated to allay the fears of a sensitive patient3 or a pointed conductor1 covered with wet leather1 may be connected with one pole1 and its point held immovable and firmly pressed down upon the orbital margin1 as near as possible to the position of the muscle it is desired to excite1 while the patient touches at intervals the sponge from the second pole held by its insulating handle in the operator's disengaged hand4 ,,sn3 ,electrolysis ,needles4 ,the chemical action of a continuous ,voltaic current is sometimes useful in the removal or dispersal of tumours1 and in the consolidation of aneurisms1 one or more needles being introduced into the tumour1 and connected with a ,voltaic battery4 ,i shall discuss this subject in our next ,lecture1 but ,i have here some of the most generally useful needles 7,fig4 #af71 and ,i have had made for them holders with eyelet-holes for the attachment of conducting wires which render the operator independent of special conducting cords1 for with a coil of insulated wire and a pocket knife he can fit up his needles in a few minutes in any way best adapted to his proposed operation4 ,illustration3 ,,fig4 #af4 ,electrolysis ,needles and ,needle-holders4 ,by pressing the spring side ,b1 the holder opens as shown in ,c1 to grasp the needle ,d4 ,the wire is twisted into the eyelet hole-,a4 ,,sn3 ,precautions in mode of ,application4 ,having now considered the more generally useful methods of application1 it may perhaps not be out of place to remind you in concluding this part of our subject that certain precautions are necessary to be observed4 ,we must keep constantly before our attention that we are prescribing or administering an exceedingly powerful remedy1 and with all new patients we should commence with a minimum dose1 watch its effect1 and if we need to increase it1 do so gradually--e4g41 muscular contraction being sought we must use the power just sufficient to produce it and no more--and so on with other applications2 and it is especially necessary to use care in applying the ,voltaic current to the face1 neck1 or any part of the head4 ,duchenne blinded a patient by suddenly applying a current from #dj cells to the facial muscles1 and he had the candour to publish his misfortune4 ,sudden applications and sudden cessations should especially be guarded against4 ,the cessation shock can1 of course1 only occur in cases where the conductors having been held immovable1 and the current gradually increased1 one or both of them has been abruptly1 and it may be inadvertently1 removed2 and ,i have known a patient so frightened by such a cessation shock as to decline further treatment4 ,the negative pole of a ,voltaic battery will1 if frequently applied to the same spot1 soon cause a sore1 and to avoid this the point of application should be slightly varied occasionally2 and let me impress upon you1 ,gentlemen1 the importance of always testing electricity upon yourselves before applying it to a patient4 ,use as many galvanometers1 or so-called 8instruments of precision10 as you like1 but use in addition the back of your left hand as a convenient approximate test for the ,voltaic1 and your thumb muscles for the ,faradaic current1 except when about to apply electricity to your patient's head or face1 and make it then an invariable rule to first apply to your own face the same strength of current you are about to administer to your patient's4 ,if you authorize your patient to have treatment carried out at home impress this rule upon whosoever electrizes him4 ,under such circumstances it is especially imperative1 for there is great belief1 even with educated persons who ought to know better1 that the benefit derived from electrization is in exact proportion to the pain given by it1 and a little personal experience is a very wholesome corrective to such a notion4 ,graduate your dose1 then1 by the number of cells employed checked by testing its effect1 and do this upon each application1 for there is no certain means of securing that the strength of either a ,voltaic or a ,faradaic current shall not have varied from day to day4 ,we have now studied1 ,gentlemen1 medical electricity1 electrical instruments1 and methods of application4 ,in our next and concluding ,lecture ,i propose to discuss the assistance that electricity affords us in diagnosis1 prognosis1 and treatment4 ,,footnotes3 #aj ,see pages #f-ag4 #aa ,see ,duchenne 7de ,boulogne7 8,on ,localized ,electrization and its ,applications to ,pathology and ,therapeutics0 7,english ,edition74 ,part ,i41 pp4 #ch-dj4 ,london3 ,churchill4 #ab ,it is often of imperative importance in the administration of the 8constant0 current that we should really localize it--not in name only1 but in fact--in some special nerve2 and this is not always quite so easy in practice as in theory4 ,,sn3 ,importance of exactitude in administering a constant current4 ,to secure the result we desire1 we must see that the cord or wire from the terminals of the battery to the electrodes is without flaw2 that the electrodes are well moistened and placed firmly in the position determined upon2 and especially that they are held quite immovable during the entire application1 for if not maintained immovable1 we shall be using not a 8constant0 but an 8interrupted0 current with totally dissimiliar physiological and therapeutical effects6 ,we must satisfy ourselves that the current from our battery is also constant1 and that we so apply it to our patients that the affected nerve shall be--as it is called--included in the circuit--that is1 between the poles1 and that the current circulates through this nerve as perfectly and continuously as it would through a piece of wire connecting the terminals of the battery4 #ac ,published by ,churchill4 ,,lecture ,,iii4 ,,electricity ,,in ,,diagnosis ,,and ,,treatment4 ,a4--,electricity in ,diagnosis4 ,,gentlemen1 ,,sn3 ,electro-,diagnosis4 ,our first two ,lectures were devoted to a consideration of electrical instruments2 the different varieties of electricity2 and the most approved methods of applying them in therapeutics4 ,to-day we have to study their uses in diagnosis1 prognosis1 and treatment4 ,,sn3 ,test of ,electro-,irritability4 ,the chief use of electricity in diagnosis is dependent upon its power of evolving muscular contraction4 ,we have seen--as ,i demonstrated to you upon my left forearm--that both muscles and nerves1 when in a normal condition1 respond to the stimulus of electricity4 ,in disease this response1 or irritability1 may remain unaltered1 or it may be increased1 decreased1 or abolished2 and our first step in electro-diagnosis should therefore be to ascertain the exact condition of electro-contractility4 ,as in practically almost all our cases we have to do with altered reaction existing only in one nerve or muscle1 or in one of two symmetrical groups of nerves or muscles1 we possess a ready means of testing irritability by ascertaining its relative condition upon opposite sides of the body1 as1 for example1 in an ordinary case of hemiplegia4 ,,sn3 ,test of ,farado-,irritability4 ,in examining such a case electrically--and the principles of procedure are the same in all cases--it is convenient to commence our investigation with the ,faradaic current1 and to ascertain the lowest power which will call into action any one of the muscles of the healthy side1 and then to apply this same strength of current to identical points of the corresponding muscle on the diseased side1 noting whether it causes contraction4 ,if so1 we decrease the power of the current1 when if contraction still occurs there is increased irritability1 or vice vers1 as the case may be4 ,having ascertained the condition of the muscle we proceed similarly to test its motor nerve1 for we shall see hereafter that in certain diseased conditions muscle and nerve irritability are affected unequally4 ,one conductor being held to an indifferent part of the body we apply a fine-pointed conductor to the most superficial point in the course of the nerve1 in the way that1 as you will recollect1 ,i electrized my left median nerve4 ,,sn3 ,test of ,voltao-,irritability4 ,we next submit the muscle and nerve to similar examination with the ,voltaic current4 ,holding both conductors immovable1 we interrupt the current for a moment by moving the 8key0 of our battery1 or if it is not provided with a key1 while one conductor is stationary1 we break the current by lifting and reapplying the other4 ,it is essential that on both sides there should be exact similarity in the application1 and that the electrodes should be placed on identical points of the muscle1 and this is especially important with the ,voltaic current1 for healthy muscle responds to it more readily when it flows down the limb1 that is1 with the positive pole nearest to the spine1 and the negative farther from it than when it flows up1 and consequently a reversal of the poles will influence the result4 ,,sn3 ,rule for strength of ,current4 ,in testing a case in which there is equal disease upon both sides--as in some cases of paraplegia--we must be guided by a knowledge of the strength of current usually required to induce contraction4 ,as a general rule1 unless a current that causes energetic and painful action in the muscles of the ball of the thumb produces some contraction1 irritability is impaired4 ,if1 in our examination of the muscle1 we find irritability normal to both currents1 we have proof of the integrity of the muscular tissue4 ,if the muscle also responds by contraction to electrization of its nerve1 we have further proof that the nerve is healthy1 and also the spinal cord at the point of origin of the nerve4 ,,sn3 ,electro-,irritability diminished4 ,if we find the irritability lessened1 there is disease of either muscular tissue1 nerve or cord2 and1 as a rule1 this will be in direct proportion to the amount of diminished irritability4 ,,sn3 ,electro-,irritability increased4 ,increased irritability points to increased vascularity or irritative lesion2 but in such cases we very seldom require the aid of electricity to complete our diagnosis4 ,,sn3 ,voltao-,irritability increased4 ,the reactions of ,faradism and ,voltaism are usually equal1 but in some cases in which muscular response to ,faradism is diminished or abolished the muscular reaction to an interrupted ,voltaic current is not only preserved but increased4 ,the diseased muscle will respond much more readily to the ,voltaic current than the corresponding muscle of the healthy side2 while at the same time it will be found on examining the nerve that there is equal diminution to both currents4 ,,sn3 ,diagnosis of ,peripheral from ,central ,disease4 ,this increased muscle reaction is due to the special irritability of muscular tissue1 and is quite independent of any nerve influence4 ,it exists only in peripheral and never in central lesion1 and by it we obtain an absolute diagnosis of such cases as local paralysis of the facial nerve from facial hemiplegia1 paralysis of the extensors of the wrist and fingers1 due to lead poisoning1 from commencing muscular atrophy1 or progressive muscular atrophy from paralysis from section of a nerve--all important questions as affecting treatment4 ,,sn3 8,the ,degenerative ,nerve ,reaction40 ,it is known as the 8degenerative nerve reaction10 as it always follows when a nerve trunk is involved in the lesion4 ,there is then diminution of ,faradaic irritability through both nerve and muscle1 diminution of reaction to the ,voltaic current when the rheophores are applied over the nerve1 and increase of reaction when they are applied over the muscle2 but there is no relation between these interesting variations in the electrical condition of nerve and muscle1 and the degree of paralysis to the will1 for there may be perfect muscular paralysis1 as in hemiplegia1 when the electrical condition of both nerve and muscle is unchanged2 but1 on the other hand1 in muscles equally paralyzed we may find absolute electrical changes in some1 and none in others4 ,we may often positively predict that these latter will rapidly recover--one instance of the use of electricity in prognosis4 ,after long disuse of healthy muscles a slight degree of diminution of electric irritability may sometimes be present1 but this is always restored by two or three ,faradizations1 and its existence is hardly likely to present any difficulty in diagnosis4 ,,sn3 ,central ,paralysis4 ,with this qualification we find that in paralysis from brain disease electric irritability is normal1 except when irritative lesion is present1 and then it is increased4 ,,sn3 ,spinal ,paralysis4 ,in paralysis from disease of the substance of the cord irritability is diminished1 and this will sometimes aid us in the diagnosis--not always easy--between commencing paraplegia and locomotor ataxy4 ,in ataxy--at least in its early stages--irritability is normal4 ,in progressive muscular atrophy it is normal as long as any muscular tissue remains4 ,,sn3 ,hysterical ,paralysis4 ,in hysterical or emotional paralysis irritability is normal1 but electro-sensibility is often much impaired4 ,,sn3 ,diagnosis between ,real and ,feigned ,disease4 ,,sn3 ,electricity as ,proof ,positive of ,death4 ,these variations will sometimes enable us to distinguish between real and pretended disease2 and1 finally1 absolute abolition of electric irritability in all the muscles of the body is proof positive of death1 so that those extraordinary people who are haunted by a fear of being buried alive may rest contented if they provide that after apparent death1 and before burial1 their bodies shall be submitted to thorough electrical examination4 ,considered solely as an aid to diagnosis1 we can get little more assistance from electricity than ,i have pointed out to you4 ,and now1 ,gentlemen1 we come to the consideration of the last and most important branch of our subject--electricity as a therapeutic agent--its scope and its limitations as a remedy4 ,,sn3 ,limitation of ,electricity as a remedy4 ,is it needful for me to say that there is too much belief and too much unbelief in its therapeutic power8 ,the men who estimate it fairly are quite the minority4 ,it is generally either much undervalued1 or else believed to be a sort of modern 8,elixir ,vit10 capable of curing a hopeless hemiplegia from destruction of brain tissue1 or a paralysis agitans from senile degeneration4 ,although electricity will do neither of these impossibilities1 yet1 considered as a remedy1 it is of great value in a wide margin of diseases4 ,it will either stimulate or soothe both nerve and muscle1 according to its variety and mode of application2 it will frequently restore voluntary movement1 it will relieve pain1 heighten temperature1 recall sensation1 coagulate the blood1 and dissolve or slowly cause the absorption of tumours4 ,b4--,electricity in ,treatment4 ,,franklinization4 ,franklinization as the oldest form of electricity and as partaking more of a general application than a local1 may be conveniently considered first4 ,administered by the various methods described at pages #f to #ag1 it has been found in the practice of the ,national ,hospital for the ,paralyzed and ,epileptic1 and in private cases coming under my own observation1 of considerable value4 ,,sn3 ,facial ,neuralgia4 ,facial neuralgia1 for example1 which has resisted other modes of treatment1 may occasionally be relieved with rapidity and permanently by drawing sparks along the track of the affected branch or branches of the trifacial nerve4 ,,sn3 ,sciatica4 ,,sn3 ,facial ,spasms4 ,sometimes also obstinate sciatica has been partially or altogether removed2 so also facial spasm1 7tic convulsif71 as in the following instance1 for permission to quote which ,i am indebted to ,dr4 ,radcliffe4 ,a female1 forty-eight years of age1 had suffered for thirteen years from spasm of the muscles of the left side of the face4 ,the distortion produced by the spasm was very great1 and was apt to be so much exaggerated by slight emotion1 even such as would be caused by having to address a stranger1 as to make speaking difficult1 and to prevent proper attention to her occupation as a small shopkeeper4 ,an experimental trial was made of electrization by sparks along the lines of the nerves distributed to the affected muscles4 ,after the third application the spasm was manifestly relieved1 the distortion being diminished1 and the paroxysms occurring less frequently4 ,by persisting with this treatment thrice weekly over a period of two months1 so great an amount of relief was obtained that little distortion of the face remained1 and the patient was able to pursue her business with comfort4 ,,sn3 ,emotional ,aphonia4 ,electrization by sparks over the larynx has been found so effective in the relief of cases of hysterical or emotional aphonia1 even those of long standing1 that it is well to use it in the treatment of these cases before having recourse to induced electricity4 ,in six or seven recent cases1 this form of application repeated twice or thrice effected a complete cure4 ,one of these cases was of nine1 another of six months' duration4 ,the remainder had lasted from four weeks to three months4 ,the seventh case did not receive any benefit from the use of static electricity1 and the other forms of the agent proved equally ineffective4 ,the case recovered slowly under general treatment4 ,,sn3 ,localized ,excessive ,sensitiveness4 ,electrization by sparks over the affected spot has often proved of great benefit in removing the localized excessive sensitiveness not unfrequently found in hysterical cases1 particularly in the spinal region4 ,,sn3 ,tremor4 ,tremor1 whether general or local1 is sometimes largely relieved by insulating the patient1 and charging him with positive electricity for a period of twenty minutes to half an hour4 ,other applications failing1 ,i would advise always1 in cases similar to the above1 a fair trial1 say half a dozen sittings1 of ,franklinization4#ad ,,electrization4 ,,sn3 ,electro-therapeutics4 ,we have seen that if we send a shock of electricity through a motor nerve the nerve becomes excited1 and responds by contraction of its muscles4 ,one form of electricity1 then1 is a stimulant1 but1 unlike other stimulants1 it admits of its action being exactly localized and its influence instantly withdrawn4 ,,sn3 ,effects upon ,nutrition4 ,there first results from such an application a larger flow of blood to the part1 with subsequent increase of temperature and general improvement in nutrition4 ,,sn3 ,electricity as a ,stimulant4 ,if muscular contraction results1 it acts in addition as an artificial gymnast1 imitating natural muscular action in a way quite impossible to any agency but electricity4 ,it is in cases where there is muscular response to it1 but not to the will1 that it is often of immense service1 and it can then be replaced by no other remedy known to medicine4 ,need ,i say that in such cases its dosage is of importance2 that only a certain amount of stimulation being needed1 this may not be carried to the point of exhaustion1 and that the application should not be continued for too long a time4 ,from ten to twenty minutes for an entire application is usually sufficient4 ,so much for the stimulant effects of electricity when administered under either of its forms in a series of intermittent 8shocks40 ,,sn3 ,the ,constant ,current4 ,but we get a very different result when we employ a constant current--that is1 a continuous stream of electricity without interruption or break in it1 and without appreciable variation in its strength4 ,one effect of the administration of such a flow of electricity is that of a sedative1 for it possesses the most remarkable power in relieving pain4 ,we have all heard of the benefit of the 8constant current0 in neuralgia1 and it is worthy of its reputation1 and will not disappoint us if we administer it with the precautions noted in my last ,lecture4 7,see foot-note1 page #eb47af ,,sn3 ,electricity possesses an influence sui generis4 ,electricity1 then1 according to its variety and method of administration1 is both a stimulant and a sedative2 but although these words may be used as convenient distinctive terms1 there is no doubt that it is something more1 and that it possesses an influence quite sui generis1 dependent1 perhaps1 upon its modification of the natural state of the electricity of the human body4 ,,sn3 ,restorative power of ,voltaic ,current4 ,the ,voltaic current enjoys a remarkable restorative power1 for it has been found that its prolonged action upon a nerve immediately after death will preserve its irritability for a length of time1 and that even in a dead nerve the lost irritability may be again established4 ,,sn3 ,electricity in ,fatigue ,diseases4 ,dr4 ,poore has particularly studied this restorative or refreshing effect of the ,voltaic current1 especially in its application to a class of diseases 7termed by him 8fatigue diseases071 and of which writer's cramp is a type1 chiefly characterized by an intense feeling of fatigue upon any attempt being made to execute certain muscular movements4 ,this tired feeling is at once removed by the application of the ,voltaic current1 either to the muscles affected or to their nerves1 and this result ,dr4 ,poore believes to be explained by an increase in the susceptibility of the muscles to the stimulus of the will4 ,be this as it may1 such an application is often most comforting1 and it is not unusual for the patient to experience immediate and most grateful relief1 and to beg for its repetition4 ,many electro-therapeutists will attribute this relief to the production of1 as it is termed1 a condition of electrotonus1 about which1 and its importance in electro-therapeutics1 a great deal has been written and disputed4 ,,sn3 ,electrotonus4 ,electrotonus is simply a name given to signify the state of a nerve while it is being traversed by an artificial ,voltaic current4 ,the effects of such an application1 of course1 depend chiefly upon the power of the current4 ,if sufficiently powerful complete functional destruction of the nerve would result1 as by a lightning flash2 and as the tension of electricity is greater at one pole than the other1 we naturally1 with currents of a certain strength1 discover modifications of irritability in the nerve when specially influenced by either pole4 ,the irritability is increased in the half nearest to the negative pole 7,katelectrotonus71 decreased in the half nearest to the negative pole 7,anelectrotonus71 and unchanged at a point midway between the two poles 7point of indifference74 ,the production of the general electrotonic state is of importance4 ,i believe these lesser variations of anelectrotonus and katelectrotonus to be practically of little moment1 and ,i advise you to disregard them in therapeutics4 ,,sn3 ,impotence4 ,the restorative effect of the ,voltaic current is frequently of benefit in sexual weakness4 ,in functional cases1 the current may be applied to the spine--positive pole to mid-dorsal region2 negative well painted over lumbar twice daily for ten minutes upon getting up and going to bed4 ,this treatment was adopted in the case of a gentleman1 fifty years of age1 who consulted me for gradual decrease of sexual power1 ending in complete impotence4 ,six weeks' treatment resulted1 the patient informed me1 in the complete restoration of the normal function4 ,very marked absorbent or resolvent effects are also exerted by the ,voltaic current1 and are probably chiefly due to its powerful chemical action1 for a current of great strength will dissolve or destroy any animal tissue whatever4 ,one application of this chemical action is found in the electrolysis of tumours2 another in the coagulation of blood in aneurisms2#ah and a third in the removal or absorption of gouty and rheumatic deposits4 ,,sn3 ,rheumatic ,gout4 ,in ,rheumatic ,gout1 ,dr4 ,poore has recorded a very successful result from the use of localized galvanization4 ,the disease had existed for three months1 but the severity of the pain had much diminished1 excepting towards evening1 when exacerbations occurred4 ,the wrist was considerably swollen1 and absolutely stiff1 the hand pronated and could not be supinated1 and the hand and fingers were immensely swollen1 so as completely to obscure their anatomy1 while the fingers were extended1 stiff1 pale1 and cold1 and the nutrition of the entire limb impaired4 ,the whole limb1 and especially the hand1 was thoroughly sponged with the negative pole1 the positive being held in the patient's other hand4 ,after the third application the swelling rapidly subsided1 and in about a fortnight the hand1 although still stiff1 had resumed its natural aspect4 ,the muscles were then faradized and shampooed4 ,,sn3 ,rheumatic ,arthritis4 ,rheumatic arthritis with nodosities is best treated by passing as strong a ,voltaic current as the patient will submit to through each swollen joint for a few minutes1 the direction of the current being frequently changed by the movement of the commutator of the poles4 ,,sn3 ,muscular ,rheumatism4 ,the pains of muscular rheumatism are almost invariably removed or mitigated by cutaneous faradization1 and so rapidly as in many cases to appear marvellous4 ,in cases that had resisted all other treatment1 an instantaneous cure has resulted1 and sufferers whose pain has for a long time obliged them to keep the arm immovable have been able directly after the faradization to execute any movement with ease4 ,with these rheumatic patients it is especially of importance that the current should be strictly limited to the skin1 carefully dried and powdered1 and should produce no muscular contraction1 or the suffering will be aggravated instead of relieved4 ,begin with a current readily bearable on your own hand1 and increase afterwards4 ,the above remarks are applicable to all varieties of muscular rheumatism1 but not to arthritic disease4 ,,sn3 ,general effects of ,electrization4 ,so much for the general effects of electricity4 ,all the structures of the body respond to its application2 the muscles and motor nerves1 as we have seen1 by contraction2 the nerves of common sensation by a burning or pricking2 and of the nerves of special sense2 the retina by a flash of light2 the auditory nerve by a sound2 the olfactory nerve by a peculiar smell2 and the gustatory by a metallic taste1 differing at the two poles4 ,the action of the ,voltaic current upon the brain is exceedingly powerful1 and the greatest care must be exercised when it is applied to any part of the head or face4 ,not more than two or three cells should be commenced with4 ,its effect should be noted1 and any increase should be made gradually4 ,with a very moderate current giddiness is produced1 and upon the sudden application of a sufficiently powerful one the patient falls down as if struck by a blow4 ,,sn3 ,general ,debility4 ,all1 or some of the more or less generalized applications1 such as ,beard and ,rockwell's generalized electrization1 the common ,faradaic and ,voltaic ,baths1 or ,radcliffe's ,charge1 are of occasional benefit in conditions of general debility1 and where general stimulation of the nervous centres is indicated4 ,the electric bath is an elegant and pleasant mode of administering electricity1 but it is less generally beneficial 7except in certain gouty or rheumatic cases7 than localized applications of electricity4 ,the statement that metallic poisons can be eliminated from the body by its agency has not yet been established4 ,,sn3 ,paralysis4 ,there are very few1 ,i think ,i may almost say not one1 of the many disorders classed under the heading of paralysis1 in which at some time or other of their progress some form of electrization is not essential to their most successful treatment4 ,where powerless to cure it will not unfrequently relieve the most distressing symptoms4 ,cases of functional paralysis from slight pressure are not uncommon1 when power may usually be restored by a few ,faradizations2 but in paralysis from severe central or peripheral lesion progress must of necessity be slow4 ,such cases1 regarded electrically1 may be most conveniently considered under the two divisions of atrophic and non-atrophic paralysis4 ,,sn3 ,atrophic ,paralysis4 ,in the great majority of atrophic cases there will be found abolition or modification of the normal electrical reaction of nerve and muscle1 but whether this is so or not1 in all cases of loss of power1 in which any muscular wasting is visible1 the localization of electricity in the wasting muscles is imperative1 and in some varieties it is the only treatment which will arrest the disease4 ,it is in these latter cases that its early administration is called for1 before the degeneration and disappearance of the muscular tissue1 and its early and judicious use will not seldom save the sufferer from being left for life with a powerless1 or withered and deformed1 limb4 ,,sn3 ,infantile ,paralysis4 ,as an illustration1 let us review the progress of a case of essential infantile paralysis1 the most common of the paralyses of children2 that form in which premonitory symptoms are often absent1 or but slight1 and where there is no rigidity4 ,very shortly after its onset1 usually within a few days1 the limb is found to be colder than its fellow1 and its muscles to be rapidly wasting2 the final result1 if untreated1 being the entire disappearance of some of them and the production of deformity4 ,in fact1 the larger number of cases of club-foot and analogous distortions are brought about by neglected infantile paralysis1 and there is no doubt that by judicious treatment1 of which early electrization is the foundation1 the majority of them might have been prevented4 ,the leading orthopdic surgeons are fully alive to this fact1 but they are powerless1 as they are rarely consulted until all the mischief has resulted4 ,,sn3 ,importance of early ,electrical ,treatment4 ,the early recognition and appropriate treatment of these cases must continue in the hands of the family practitioner1 and he must decide whether or not they are to continue1 as at present is unfortunately too commonly the case1 without any serious attempts at restorative treatment until commencing deformity compels attention to them4 ,as soon as the medical attendant is summoned--and this is frequently only because the parents have noticed that the child is lame--he should carefully examine the muscles electrically1 and unless there are head symptoms present1 and this is very seldom1 he should electrize each muscle daily with that current to which it responds1 and of a strength just sufficient to produce muscular contraction4 ,if the powerless muscles have preserved their ,farado-contractility it may be confidently predicted that they will rapidly recover2 but it will almost invariably be found that while ,farado-contractility is diminished or abolished1 there is increased response to the interrupted ,voltaic current4 ,they should be treated then with this current alone4 ,hot spongings and shampooings should also be employed1 and it is of great importance that in the intervals of treatment the temperature of the affected muscles should be maintained at as high a degree as possible4 ,if the leg is affected1 a stocking of pure spun silk should be constantly worn1 day and night1 in addition to the ordinary clothing2 if the arm1 a silken sleeve4 ,,sn3 ,importance of active and passive movements in ,paralysis4 ,when in any form of paralysis ,,any amount of voluntary power has been restored by electricity1 it is most important that the patient should be encouraged to use the limb and practise various movements4 ,passive movements are of equal importance1 and the paralyzed muscles should be frequently exercised by this mode to the fullest extent of their normal movements4 ,for example1 if the extensors of the hand and fingers are paralyzed1 the hand and fingers should be passively flexed and extended completely1 at intervals of a few seconds1 for some minutes1 and so on with all the paralyzed muscles in succession4 ,,sn3 ,rule for ,muscular ,electrization4 ,as soon as there is return of reaction to ,faradization1 ,faradization should be alone used1 and the rule in all cases of localized muscular electrization1 muscular contraction being sought1 is to use that current to which the muscles respond1 and ,i do not know of any exception to this rule2 but a successful result in severe cases of atrophic--not alone infantile paralysis1 but all varieties of atrophic paralysis--is brought about by painstaking1 daily1 tedious1 uninteresting treatment1 with no chance of brilliant or rapid results1 but which if thoroughly1 faithfully1 and patiently carried out1 will reward us by progressive improvement1 and sometimes--even in cases regarded not long ago as quite hopeless--complete recovery4 ,,sn3 ,rigid form of ,infantile ,paralysis4 ,there are certain forms of paralysis affecting children where the muscles are rigid4 ,localization of any form of electricity in these rigid muscles is quite useless2 but if these cases depend upon adhesions or exudations into the medulla their absorption may possibly be promoted by localizing a ,voltaic current in the superior cervical ganglia of the sympathetic2 two small conductors1 leather1 tipped and well-moistened in connection with the poles of a ,voltaic battery being applied for four or five minutes to the bottom of the auriculo-maxillary foss on both sides4 ,there seems no doubt that such an application causes a dilatation of the blood-vessels of the base of the brain1 and is likely therefore to promote absorption4 ,,sn3 ,traumatic ,paralysis4 ,in all cases of traumatic lesion--as by section of a nerve--the paralysis is atrophic1 and the treatment ,i have recommended in infantile paralysis should be assiduously employed4 ,mitchell1 of ,philadelphia1 whose experience of military surgery is unrivalled1 commences electrical treatment and shampooing within a fortnight of the wound1 unless there are special circumstances to contra-indicate it4 ,lead palsy requires similar treatment2 so does1 perhaps1 the commonest form of peripheral palsy--facial palsy from neuritis of the facial nerve4 ,,sn3 ,caution necessary in ,electrizing ,facial ,muscles4 ,in electrizing the facial muscles there is one caution necessary--especially to observe the rule of electrizing the muscles equally--for ,i have several times met with a contraction resulting from a too energetic ,faradization of some individual facial muscle1 to the neglect of the group with which it is in correlative action4 ,such a contraction may sometimes be removed by localizing in it for about five minutes a constant ,voltaic current from eight or ten cells2 but in the most favourable cases an unnatural expression of countenance will generally persist for a long time1 from the non-recovery by the muscles of their perfect 8tone10 that quality which imprints upon each face its characteristic features1 and which has been called the 8,gymnast of the ,soul40 ,,sn3 ,wasting ,palsy4 ,in that most distressing disease1 ,cruveilhier's atrophy or wasting palsy1 medication is altogether useless1 and our one hope--not invariably a forlorn one--is in electricity4 ,localized ,faradization to the muscles1 alternately with ,radcliffe's ,positive ,charge1 together with galvanization of the sympathetic or of the spinal cord1 admit of trial4 ,,sn3 ,hemiplegia4 ,in non-atrophic paralysis--of which hemiplegia may be taken as a type--the propriety of electrization1 and especially the proper moment for its application1 requires careful consideration4 ,in both brain and spinal cord disease muscular electrization is not advisable until some time after the attack1 or until the muscles exhibit signs of impairment of nutrition from disuse4 ,as long as there is rigidity--especially with increased reflex action--any stimulant application of electricity is not likely to do good1 and may do harm2 but in older cases--both hemiplegic and paraplegic--cases of from six to eighteen months' duration--the immediate benefit to be derived from localized electrization is often remarkable1 especially in those cases where1 after a partial return of voluntary movement1 the patient suddenly stops short1 and for weeks or months makes no progress4 ,as the sequel of electrization1 the hemiplegic patient able to use the arm slightly1 but not to feed himself1 may regain this power1 to his infinite comfort1 and the paraplegic patient1 able with difficulty to drag himself along by crutches1 is enabled to walk by the aid of a stick4 ,some improvement is usually soon obtained1 and it is progressive for1 perhaps1 two or three months1 after which continued electrization fails to increase it2 but at a subsequent period--six months afterwards--a renewed electrization may give rise to a new improvement2 but be this as it may1 whenever in these old-standing cases we see signs of impaired nutrition1 it is wise to occasionally stimulate the muscles by ,faradism4 ,we should endeavour--in the words of the late ,nestor of modern medicine1 ,sir ,thomas ,watson--8to preserve the muscular part of the locomotive apparatus in a state of health and readiness1 until peradventure that part of the brain from which volition proceeds having recovered its functions1 or the road by which its messages travel having been repaired1 the influence of the will shall again reach and reanimate the palsied limbs40#ai ,,sn3 ,direct application of ,voltaic ,current to ,brain4 ,in hemiplegia the propriety of a direct application of the constant ,voltaic current to the brain must be thoughtfully considered4 ,in selected cases1 where the clot or softening is of limited extent1 its removal may be accelerated by a carefully localized current--two or three cells--for two or three minutes to the injured hemisphere1 followed by ,voltaization of the cervical sympathetic 7so-called7 for four or five minutes4 ,after such an application there follows--according to ,althaus--8greater ease in the head1 as well as in the limbs1 and if there has been pain this is relieved40 ,,sn3 ,electricity in ,spinal ,paraplegia4 ,similarly the absorption of the inflammatory products may be promoted in the earlier stages of spinal disease1 by localizing the ,voltaic current in the parts affected1 especially where pain is present1 and we have reason to suppose that the myelitis is circumscribed4 ,the daily application of the positive pole for about five minutes1 and with from ten to fifteen cells1 to the painful spot--the negative pole being held to an indifferent part of the body--is likely to promote absorption4 ,at any rate it will sometimes relieve the pain4 ,in the later stages of paraplegia1 as soon as there is diminution of electro-irritability in the paralyzed muscles they should be sponged with the ,voltaic current1 or ,faradized2 and where ansthesia is present1 a good painting with the wire brush will often be of service4 ,,sn3 ,paraplegic ,constipation4 ,paraplegic constipation may frequently be relieved by ,faradization of the abdominal muscles1 and the troublesome dribbling of urine1 so often present1 by external ,faradization of the bladder--one pole to the pubes1 and two sponges from the second pole--one to the sacrum and the other to the perineum4 ,incontinence of urine in children may be similarly treated4 ,,sn3 ,emotional ,paralysis4 ,cases of hysterical or emotional paralysis may frequently be benefited by the application of the wire brush1 which also sometimes acts like a charm in removing ansthesia1 which1 although originally of central origin1 continues after the removal of its cause4 ,ansthesia from section of a nerve is sometimes persistent in this way after repair of the nerve lesion4 ,,sn3 ,locomotor ,ataxy4 ,the wire brush is also useful in sometimes removing the ansthesia present in locomotor ataxy1 some cases of which may be largely benefited also by the constant current to the spine--one pole to nape of neck1 and the other to the lower lumbar vertebr4#bj ,,sn3 ,electricity in ,mental ,diseases4 ,electricity is coming into use in mental diseases4 ,faradism1 and especially cutaneous irritation with the wire brush1 would seem to be most suitable for cases accompanied by depression or torpor1 the stimulating effects being of service in inspiriting the patient1 while the soothing influence of a direct application of the constant ,voltaic current to the brain may be employed in cases of over-excitement requiring a sedative4 ,,sn3 ,diseases of ,women4 ,it is remarkable that electricity should have been so little used in this country in the diseases of women4 ,,sn3 ,electricity as an ,emmenagogue4 ,according to ,golding ,bird1 it is the only true emmenagogue that we possess4 ,be this as it may1 all of its forms are serviceable in stimulating the secretions1 and may be employed with success in cases of suppression of the catamenia from a torpid condition of the uterine organs4 ,a generalized application will often suffice4 ,let the patient sit with her feet in tepid salt and water1 in which is immersed a wire from one of the poles of an induction instrument in action1 while a large sponge from the other pole is held applied to the lumbar region4 ,strength of current as much as she will bear4 ,time1 ten to fifteen minutes4 ,the application should be made twice daily for the three or four days preceding the usual catamenial period4 ,if this method fails in its object1 direct electrization must be resorted to2 but ,franklinization most often succeeds4 ,on the ,continent electricity has been largely employed in the treatment of inertia uteri in the second stage of labour1 also in producing premature labour2 in the resuscitation of still-born children1 and in uterine displacements4 ,,sn3 ,the ,advantages of ,electrization over ,ergot4 ,we possess other remedies for these conditions1 but in labour its advantages over the administration of ergot1 include the rapidity and certainty of its action1 the exactness with which its dose can be regulated1 and the strength and regularity of the contractions which it produces4 ,it admits also of being used in extreme cases in which the power of swallowing has been lost1 or where everything is rejected from the stomach1 while it never exerts in any way--as ergot is said to do occasionally--any injurious effect upon the new-born child4 ,,sn3 ,faradization in ,post-partum ,hmorrhage4 ,gentlemen1 it is my firm belief that if a ,faradaic instrument were at hand1 and properly used1 there would never be another death from post-partum hmorrhage4 ,the ,faradaic current1 thoroughly localized in the uterus1 will always produce its contraction1 not only while life persists1 but even for a limited time after death1 but failure in localizing electricity in an organ1 withdrawn from sight and covered with thick muscular tissue1 is especially liable to occur1 unless the details of application are conducted with extreme care4 ,assume the case to be an example of severe post-partum hmorrhage1 that the ordinary resources of medicine have failed the obstetrician1 and that he fears every moment may be his patient's last1 but he has an induction instrument at hand4 ,let him waste no time1 but at once introduce his right hand into the cavity of the uterus and grasp in his left the moistened sponge attached to one of the conductors of the instrument in action4 ,let an attendant1 holding by its insulating handle the conductor from the other pole 7which should be a well-moistened sponge7 thoroughly paint with it1 as it were1 the abdominal parietes1 pressing it with considerable force against the practitioner's hand1 and afterwards apply it to the lumbar region4 ,contraction of the uterus will invariably result if the current used be of sufficient power4 ,,sn3 ,uterine ,neuralgia4 ,in my own hands an intractable case of uterine neuralgia was perfectly cured by the ,voltaic current2 and ,i have knowledge of a case of sterility which the localization of the ,voltaic and ,faradaic currents alternately would seem to have removed4 ,,sn3 ,sterility4 ,one conductor was applied to the os1 and two sponges from the second pole--one to the position of each ovary4 ,the applications were made thrice a week for a fortnight before each menstrual period1 and for a period of four months4 ,conception followed1 and the patient1 who had been married for thirteen years1 in due course gave birth to her first child4 ,,sn3 ,paralysis of ,nerves of ,special ,sense4 ,the stimulant effects of electricity are occasionally beneficial in the treatment of paralysis of the nerves of special sense1 especially of the optic and auditory nerves1 while its use has been advocated in a multitude of diseases to which ,i shall not further refer1 than by saying that a clear comprehension of the principles of electro-therapeutics will prevent the occurrence of difficulty in any special application of them2 and let us shortly recapitulate the most important of these principles4 ,,sn3 ,rsum of general principles of ,electro-therapeutics4 ,we have seen that electricity is a stimulant1 a sedative1 a restorative1 and an absorbent4 ,its stimulant properties are chiefly of use in diseases of debility1 and notably in paralysis--its sedative properties in the alleviation and removal of pain and spasm1 and notably in neuralgia--its restorative properties in fatigue diseases1 notably writer's cramp--and its absorbent properties in exudation diseases1 and notably in gout and rheumatism4 ,the dose of electricity consists of the addition of two factors--firstly1 the strength of the current1 whether ,voltaic or ,faradaic2 secondly1 its duration4 ,it is of essential importance that we do not overdose our patient1 but we are little likely to do this if we adhere to the two cardinal rules--to use the minimum power which will produce the results we desire1 and not to unduly prolong our application3 and really this question of 8dosage0 forces us to consider how far it is advisable for the medical practitioner who prescribes electricity to sanction its administration by the patients themselves4 ,while there is no doubt that the most explicit directions will often be misunderstood1 or fail in being correctly carried out1 yet it would be practically impossible 7to say nothing of the expense to the patient7 for any medical man to himself apply electricity daily for a lengthened period2 and we are compelled1 in certain cases1 to do our best in instructing some one attendant of the patient how to carry out the treatment1 making her do this a few times in our presence1 and looking sharply after her afterwards1 and in addition explaining everything as fully as possible to the patient1 or the patient's friends4 ,moreover1 we must not lose sight of the fact that1 with electricity as with other remedies1 the skill of the physician is shown in determining how1 when1 and in what dose to administer it1 and his judgment in selecting those cases in which its administration may be wisely committed to others4 ,in conclusion1 ,gentlemen1 allow me to thank you for the attention with which you have listened to these imperfect ,lectures4 ,i fear that ,i have failed in doing full justice to their subject2 but ,i trust that ,i have succeeded in indicating the importance of electricity1 as a supplement to1 not as a substitute for1 the more ordinary resources of therapeutics3 in removing any doubt as to the class of cases calling for its employment2 in supplying any want of information regarding details of its application2 and especially in proving its claim to be more fully employed in your daily practice4 ,a theoretical belief in its efficacy is widespread in our profession1 its frequent use is yet in the future1 but ,i hope a not distant future4 ,gentlemen1 with you rests the decision whether this shall or shall not be4 ,you will decide it not by the dictum of any specialist1 but by the general voice of the profession1 declaring your verdict as founded alone on your own personal experience4 ,,footnotes3 #ad ,since writing as above1 in #ahgc1 our knowledge of the beneficial effects of ,franklinism has been very largely added to and the improved apparatus1 described at page #aj1 has enabled the treatment to be conducted with a degree of precision and success impossible with the comparatively imperfect instruments in use at that date4 ,,sn3 ,importance of distinguishing between the ,positive and ,negative ,charge of ,franklinism4 ,dr4 ,radcliffe has contended for many years that the effect of a charge of positive electricity differs altogether therapeutically from that of a negative charge2 and ,giacomini 7quoted by ,duchenne#ae7 attributes a hyposthenic influence to the negative charge4 ,he contends that this charge is derived from the nerves of the patient instead of from the ground as is the positive charge1 and it is ranked by the ,italian ,school among their most valuable hyposthenisants4 ,according to ,giacomini the 8patient is de-electrized1 is consequently deprived of a greater or less quantity of a stimulant analogous to heat and undergoes a real hyposthenisant effect4 ,erysipelatous tissues may be seen to become blanched under its influence1 and chronic inflammations undergo an unquestionable improvement4 ,headaches and neuralgic pains have been instantly relieved by this kind of electric flux as by the application of ice1 which abstracts heat1 and perhaps at the same time electricity also40 ,in reference to the above it has been proved by various physicists that the natural electrical nerve current is strengthened by the positive charge1 and weakened by the negative--and hence it would seem to be established that ,dr4 ,radcliffe's contention is the right one2 and that these two charges are literally 8wide as their poles asunder0 not only physically1 but therapeutically1 and this divergence is more important when we recall to mind that when a patient is insulated1 not only does the electricity accumulate upon the surface of the skin but that the whole body is saturated with it as a sponge may be with water4 ,,sn3 ,franklinization in ,conditions of ,debility4 ,in my own experience the positive charge has been of great good as a most potent restorer when the organism from any cause has become enfeebled4 ,in the general weakness of old age it would seem to have been beneficial upon several occasions in resuscitating vital action and in imparting new force and energy4 ,i have also used it with the best results in conditions of debility following acute diseases1 as for example in convalescence from fevers2 in cases of general prostration from overwork or anxiety--and in some cases of phthisis and other wasting diseases4 ,in certain varieties of mental disease--notably melancholia--it is often of service1 and in cerebral anmia1 in asthma1 in inveterate insomnia1 and in all functional uterine irregularities it should be employed before1 not after1 all other therapeutic agencies have been exhausted4 #ae ,see 8,duchenne on ,localized ,electrization10 ,english ,edition1 page #d4 ,churchill4 #af ,in the treatment of ,neuralgia by the constant current the electrodes should be so applied as to include between them the part or nerve affected--the number of cells the highest number that can be borne without pain1 i4e41 the current to be distinctly but not painfully felt1 both electrodes being immovable4 ,,sn3 ,electricity in ,neuralgia4 ,time1 five to ten minutes4 ,frequency1 as often as the attacks of pain recur4 ,i am satisfied that in severe cases this rule of application is essential--that the influence of the current shall be maintained as much as may be in the irritable nerve during the intervals of pain4 ,in one case under my care the patient was galvanized with benefit #bg times in the #bd hours2 but in milder cases one or two applications daily will generally suffice4 ,a weak current from two or three cells--the electrodes being applied to each temple for one or two minutes--will sometimes dissipate a severe headache4 ,this soothing influence of the current is often useful in allaying ,,spasm1 as1 for example1 in spasmodic torticollis4 ,the current should be localized in the irritable muscles3 and it is generally advisable to energetically ,faradize their antagonists and to conjoin with the electrical treatment appropriate gymnastic exercises1 alternating with periods of perfect rest4 ,i may mention that the only recorded case of improvement in that remarkable condition of spasm first described by ,hammond under the name of ,athetosis resulted from the ,voltaic current4 ,the case was brought before the ,medico-,chirurgical ,society by ,dr4 ,gowers1 and is published in the #dith volume of their ,transactions4 ,the reader will find the subject of neuralgia very exhaustively considered in ,dr4 ,anstie's work4#ag ,he quotes some extremely severe cases in which the effect of ,electrization was to arrest the pain in a few sittings1 and to procure a remission for several days or even weeks2 and ,i have had several cases which ,i believe to have been as fairly cured as an ague fit may be said to be cured by quinine4 ,dr4 ,russell ,reynolds also quotes the case of a patient1 a lady1 who for twenty years had suffered from an extremely severe neuralgia of the ophthalmic branch of the fifth nerve1 which recurred daily and from which her health had greatly suffered4 ,it was not only relieved but removed by a single application4 #ag 8,neuralgia and the ,diseases that resemble it40 ,by ,francis ,e4 ,anstie1 ,m4,d41 c4 ,london3 ,macmillan and ,co4 #ahga4 #ah ,electrolysis is1 of course1 chiefly applicable to tumours which1 from their nature or situation1 are difficult or impossible to be removed by the knife2 and1 perhaps1 also to malignant tumours2 for whether or not the ,voltaic current exerts a special destructive influence upon diseased germs1 it seems certainly proved that there is a less frequent return of cancerous growths removed by its agency than by ordinary operative procedures or by caustics4 ,,sn3 ,electrolysis of ,tumours4 ,this treatment of malignant tumours by electrolysis is yet sub judice1 but the evidence in its favour has recently much accumulated1 and its full and exhaustive trial by competent observers possessing the opportunities of large hospital practice ought not to be much longer delayed4 ,,sn3 ,electrolysis of ,malignant ,tumours4 ,neftel1 of ,new ,york1 who is its chief advocate1 contends that malignant tumours are at first entirely local1 and he explains their recurrence1 after removal by the knife1 from the fact of the impossibility of the whole of the diseased mass being excised1 as apparently healthy parts when microscopically examined show that they have already become infected4 ,electrolysis he considers acts not only on the tumour but also on the surrounding tissues1 the current being diffused to some distance in all directions4 ,after electrolysis he applies a mild and not painful current for from a quarter to half an hour daily to the locus morbi1 and continues this for some months4 ,in one of his cases a mammary tumour existed of the size of a small orange4 ,three needles1 from the negative pole of thirty-five cells1 were inserted for half an hour under chloroform1 and the operation was repeated thrice at intervals of a week1 daily external galvanization being also used4 ,the tumour gradually became smaller1 and at last disappeared1 but external treatment was continued for several months4 ,at the end of a year there had been no relapse4 ,in another case1 in which the tumour had been excised by ,marion ,sims1 it reappeared1 and was again removed by the same surgeon1 and pronounced cancerous4 ,it again reappeared and was then electrolyzed1 upon three occasions1 by two1 three1 and four needles respectively1 and with a current gradually increased from ten to thirty cells4 ,the tumour by degrees grew less1 and in three months was entirely dispersed2 while1 when the patient died from another disease three years afterwards1 there had been no recurrence4 ,,sn3 ,aneurismal ,electro-puncture4 ,electrolysis has been successfully employed in several cases of aneurism4 ,where pressure and ligature admit of application1 it is hardly necessary to say that the preference should be given to them2 but many internal aneurisms1 and especially aortic aneurisms1 cannot be thus treated1 and in such cases the question of electro-puncture should be carefully considered1 and1 when called for1 it should not be too long delayed4 ,two fine1 sharp1 and carefully insulated needles1 one connected with each pole1 should be introduced into the aneurismal sac1 and the current allowed to pass for from half an hour to an hour1 the needles carefully withdrawn1 and their punctures covered with a bit of lint soaked in collodion or styptic colloid4 ,authorities are divided as to the kinds of aneurism calculated for electro-puncture1 but there is no doubt than an aneurism pressing on the parietes1 but not having actually perforated them1 is the best adapted for this treatment1 and that it is contra-indicated where the sac is of large size1 or where large trunks issue from it4 #ai ,the following is an illustrative case3-- ,a lady1 forty-one years of age1 had suffered from right hemiplegia for eighteen months1 and described her condition as having remained without improvement for the past six months4 ,she had recovered sufficiently to walk with the aid of a stick1 but the movements of the arm were very weak1 especially those of the deltoid1 extensors of the fingers1 and individual muscles of the hand4 ,faradic contractility was somewhat lowered1 but there was no rigidity4 ,the muscles were carefully ,faradized with a current just sufficiently strong to produce their contraction4 ,the entire application occupied about fifteen minutes1 and was made once daily4 ,after a fortnight's electrization she was able to raise the arm to a right angle with the body1 and to use the hand to feed herself1 neither of which had she been able to do before treatment4 #bj ,the following is an extract from ,dr4 ,sturge's ,report of the results of treatment at the ,national ,hospital for the ,paralyzed and ,epileptic3-- 8,in the division of ,muscular ,atrophies some striking cases have occurred1 and in all of these the improvement is mainly due to the electrical treatment prescribed4 8,a patient1 with atrophy of some of the muscles of both arms of six months' standing1 which incapacitated her from dressing herself or cutting her food1 or doing much household work1 was discharged at the end of three and a half months1 able to feed and dress herself1 sew1 and perform almost any domestic duty4 8,another woman1 with atrophy of the muscles of the forearm of several years' standing1 and who was similarly incapacitated from almost all use of the hands1 went out1 after a month's treatment1 able to dress and feed herself1 and to perform many actions that were before impossible for her4 8,a man came to the hospital with atrophy of many muscles in various parts of the body1 more especially in the left arm1 which he was unable to move from the side4 ,he went out able to lift his arm well over his head1 and with much increased strength in the limb4 8,another man1 in a very similar condition1 was also greatly benefited2 and whereas on admission he could barely bend the right arm at the elbow1 after three months' treatment he was able to use a hammer with the arm40 ,,index4 ,bath1 ,electric1 #db ,battery1 ,accessories of1 #ce ,faradaic1 #bi ,hospital ,combined1 #cc ,portable1 #ah ,voltaic1 #bj ,voltaic1 ,essentials of1 #bg ,cautions in ,electrizing ,facial ,muscles1 #he ,cells1 ,voltaic1 #ah ,conducting ,cords1 #ce 8,constant ,current10 importance of exactitude in administering1 #eb ,cords1 ,conducting1 #ce ,current1 ,constant1 ,radcliffe's ,variety of1 #da ,degenerative ,nerve ,reaction1 #ff ,diagnosis between ,real and ,feigned ,disease1 #fg of ,central ,paralysis1 #ff ,electro1 #fb of ,peripheral from ,central ,disease1 #fe of ,hysterical ,paralysis1 #fg of ,spinal ,paralysis1 #ff ,dischargers1 ,improved1 #af ,electricity as ,proof ,positive of ,death1 #fg ,electricity in ,diagnosis1 #fb ,varieties of1 #e ,methods of applying1 #cg the ,galvanometer as an aid to the ,dosage of1 #bb ,electrization1 #ga as a ,constant ,current1 #gb as a ,stimulant1 #gb ,central1 #dd ,cutaneous1 #ec ,direct1 #di in ,diseases of ,women1 #ij ,effects of upon ,nutrition1 #gb in ,fatigue ,diseases1 #gd in ,general ,debility1 #hj ,general effects of1 #gi in ,hemiplegia1 #he ,indirect1 #ej in ,locomotor ,ataxy1 #hh ,muscular ,rule for1 #hc in ,mental ,diseases1 #hi in ,neuralgia1 #gc in ,paralysis1 ,atrophic1 #ha in ,paralysis1 #hj in ,paraplegic ,constipation1 #hh in ,paralysis1 ,emotional1 #hh in ,paralysis1 ,infantile1 #ha in ,paraplegia1 #hh in ,paralysis of ,nerves of ,special ,sense1 #ib in ,post-partum ,hmorrhage1 #ia in ,paralysis1 ,traumatic1 #hd ,localized1 #dd in ,wasting ,palsy1 #he of ,auditory ,nerve1 #eg of ,bladder1 #ee of ,brain1 #ef of ,central ,organs1 #eg of ,internal ,organs1 #ed of ,larynx1 #ee of ,male ,genital ,organs1 #ee of ,ocular ,muscles1 #eg possesses an influence sui generis1 #gd precautions in1 #ei of ,rectum1 #ed ,restorative ,power of1 #gd of ,retina1 #eg of ,spinal ,cord1 #eg of ,sympathetic1 #ef of ,uterus1 #ee ,electrical ,static ,machine1 #g1 #aj ,static ,machine with ,fly-wheel1 #ab ,winter's ,machine1 #h ,electrolysis of ,tumours1 #gf in ,aneurisms1 #gg ,needles for1 #eh ,electrotonus1 #ge ,engine1 ,gas1 ,bischoff's1 #i ,faradism1 #bh ,faradization1 ,general1 #dc ,franklinism1 #f ,franklinization1 #fh by ,sparks1 #af ,distinction between ,positive and ,negative ,charge of1 #gj in ,conditions of ,debility1 #ga in ,emotional ,aphonia1 #fi in ,facial ,neuralgia1 #fh in ,facial ,spasm1 #fh in ,sciatica1 #fh in ,localized ,excessive ,sensitiveness1 #gj in ,tremor1 #gj ,modes of ,generating1 #g1 #ae ,galvanism1 see ,voltaism ,galvanization1 ,central1 #dd ,galvanometer as an aid to the ,dosage of ,electricity1 #bb ,irritability1 ,electro1 #fb ,farado1 #fc ,voltao1 #fc ,electro1 ,diminished1 #fd ,electro1 ,increased1 #fe ,voltao1 ,increased1 #fe ,paralysis1 ,importance of ,early ,electrical ,treatment in1 #hb ,rigid ,forms of1 #hd ,rheophores1 ,different ,kinds of1 #dg ,voltaic ,cells1 #ah ,current1 ,resolvent ,effects of1 #gf ,voltaism1 #ag and ,faradism1 ,points of ,distinction between1 #ah ,,printed ,,by ,,ballantyne1 ,,hanson ,,and ,,co4 ,,london ,,and ,,edinburgh 99 99 99 99 99 ,,by ,,the ,,same ,,author4 ,,preparing ,,for ,,publication4 ,a ,,manual ,,of ,,diseases ,,of ,,the ,,nervous ,,system4 ,within the past few years the treatment of ,diseases of the ,nervous ,system has grown up into a recognised speciality in the ,medical ,profession4 ,recent investigations1 physiological1 clinical1 and pathological1 have cast a flood of light upon its study1 and it possesses--as a separate field of practice--,special ,hospitals1 and a voluminous and rapidly extending literature4 ,under these circumstances the ,author1 although fully conscious of the extreme difficulty of presenting1 within a small compass1 an adequate view of our present knowledge1 feels that a concise introduction to neuro-pathology may not be unacceptable to students and junior practitioners4 ,it will be his endeavour to give the results of the best work by the many distinguished physicians1 both ,english and ,foreign1 who have so completely made this department of medicine their own2 to impart as much practical information as possible2 to give an analysis of the principles which ought to govern our treatment of diseases of the ,nervous ,system2 and to direct especial attention to the importance of early diagnosis4 ,he hopes to omit nothing really essential1 and to make the work a safe and trustworthy guide to the practice of the speciality upon which it will treat4 ,,london3 ,j4 ,a4 ,,churchill4 99 99 99 99 99 ,,price #es41 #ce ,,inches ,,by #ba ,,inches4 ,with #bj ,illustrations1 c4 ,illustration3 ,a ,,map ,,of ,ziemssen's ,motor ,points of the ,human ,body 7,a ,,guide ,,to ,,localized ,,electrization74 ,,by ,,herbert ,,tibbits1 ,m4,d41 c4 99 99 99 99 99 ,,translated ,,and ,,edited ,,by ,,dr4 ,,tibbits4 ,part ,i4 #hvo1 pp4 #cbb1 price #gs4 #f;d41 with #ib ,illustrations1 and ,notes and ,additions by the ,translator1 ,a ,,treatise ,,on ,,localized ,,electrization1 ,,and ,,its ,,applications ,,to ,,pathology ,,and ,,therapeutics4 ,by ,dr4 ,g4 ,b4 ,,duchenne 7,,de ,,boulogne74 ,,contents4 ,,chap4 ,i4--,medical ,electricity4 ,the ,physiological and ,therapeutic ,properties of ,static1 ,galvanic1 and ,induced ,electricity4 ,,chap4 ,,ii4--,localized ,electrization4 ,the ,principles and ,methods of ,procedure in the ,local ,application of ,electricity2 7a7 of ,galvanic ,electricity 7,galvanization72 7b7 of ,induced ,electricity 7,faradization74 ,,chap4 ,,iii4--,historical and ,critical ,observations upon the ,principal ,methods of ,electrization3 7a7 ,electro-puncture2 7b7 ,electrization by ,reflex ,action2 7c7 ,therapeutic ,value of ,localized ,faradization2 and 7d7 of ,galvanization4 ,,chap4 ,,iv4--,electro-,medical ,instruments1 with regard to their ,application in ,pathology1 ,physiology1 and ,therapeutics4 ,the ,first ,part of ,duchenne's work is devoted to ,,methodology1 ,,and ,,is ,,complete ,,in ,,itself4 ,the admirable selection by ,dr4 ,poore from ,duchenne's ,clinical ,works 7published by the ,new ,sydenham ,society7 renders unnecessary any further publication in extenso of ,duchenne's most voluminous treatise4 8,duchenne's great work has for years held its place as the most complete on the subject of which it treats1 and ,dr4 ,tibbits1 by presenting us with an ,english version of the forthcoming ,third ,edition1 has earned the gratitude of the profession in this country4 8444 ,the reader will find himself so thoroughly instructed in the principles underlying the medical employment of electricity1 as well as in all the methods of applying it1 that the work can hardly fail largely to increase the use of this powerful and often valuable agent4444 ,the translation itself is very creditable1 and reads with almost as much smoothness as original ,english composition1 while the experience of the translator in the ,electrical ,room of the ,national ,hospital gives great value to his notes and additions4 ,we are happy to congratulate him upon having so far accomplished an undertaking of much utility40--,the ,lancet4 8,we have to congratulate ,dr4 ,tibbits upon his successful labours thus far4 ,this instalment promises that the results of the best subsequent work will be incorporated into ,duchenne's own treatise with so much judgment and adequacy as to make this ,edition an independent standard4444 ,the tentative and accurate spirit of the master has found its kin in the spirit of his follower1 and we see little in the work of either open to cavil or correction40--,british and ,foreign ,medico-,chirurgical ,review4 99 99 99 99 99 ,second ,edition1 ,revised and ,enlarged1 with #ie ,illustrations1 #is4 ,a ,,handbook ,,of ,,medical ,,surgical ,,electricity ,,by ,,herbert ,,tibbits1 ,m4,d41 ,,etc4 ,,contents4 ,,chap4 ,i4--,electricity and ,electro-,medical ,instruments4 ,,ii4--,the ,application of ,electricity4 ,,iii4--,electricity as an aid to ,diagnosis4 ,,iv4--,electricity in ,medicine4 ,v4--,electricity in ,surgery4 ,,vi4--,electricity in ,midwifery and the ,diseases of ,women4 ,opinions of the ,medical ,press4 8,this work fills up a hiatus in the literature of medical electricity4 ,it purposes to teach 7to use the words of the preface7 #8the busy practitioner not only when to use electricity1 but in explicit and full detail how2' and in #8moderate bulk to contain only what it is essential to master4' ,dr4 ,tibbits' object has been to give the results of the best work1 and to this end he has availed himself freely of the large experience of the ,electrical ,room of the ,national ,hospital for the ,paralysed and ,epileptic4 8,the work is what it professes to be1 and is a handbook in the best sense of the work4 ,the book1 indeed1 answers thoroughly to the author's description3 that he has #8throughout endeavoured to keep constantly in view the practitioner rather than the theorist1' especially in points of detail which are of importance in order to secure the successful application of electricity1 and to insure 7a not insignificant matter in this respect7 the comfort of the patient40--,the ,lancet4 8,there is not a word of exaggeration1 or of fanciful hypothesis in the book1 and1 above all1 there is not the least suggestion that there is after all a mystery behind1 and that the reader would do well to come to an expert for advice4 ,on the contrary1 everything is made so clear that any practitioner1 whether he previously knew anything of electricity or not1 may from this book at once begin the practical use of it1 and if there are any lingering doubts in the minds of some ultra-conservative persons as to the practical value of electrical treatment1 this book should dispel them4444 the busiest practitioner can1 without difficulty1 learn how to effect a large amount of good which he was previously quite unable even to attempt40--,the ,practitioner4 8,as ,medical ,superintendent of the ,national ,hospital for the ,paralysed and ,epileptic1 as well as through private practice4 ,dr4 ,tibbits has had ample opportunities of studying the application of electricity to medicine1 and in the volume under notice1 which aims principally at giving full and explicit details within convenient limits1 how to use electricity1 we are bound to say this object is fairly carried out40--,the ,dublin ,journal of ,medical ,science4 8,the exact value of electricity as a therapeutic agent is imperfectly understood4 ,that it is of great value in some cases as a means of improving nutrition1 relieving pain1 and exercising disused muscles1 is undoubted1 but still its exact value in all cases remains to be settled1 and in ,dr4 ,tibbits' book we find a guide which will1 at all events1 help us to a solution of some of our difficulties4--,the ,medical ,times and ,gazette4 8,dr4 ,tibbits1 who is known as an authority upon electricity1 has written a concise book upon this subject for the general practitioner1 embracing only the valuable part of the existing knowledge4 ,the work is written in a condensed style1 and is well adapted for the practitioner who does not make a specialty of electrical treatment40--,the ,new ,york ,medical ,journal4 ,,london3 ,j4 ,a4 ,,churchill4 99 99 99 99 99 ,,directions ,,for ,,using ,,the ,,hammond ,wall ,cabinet ,,manufactured ,,by ,,the ,,waite ,,bartlett ,,man',f',g ,,co41 #adc ,east #bc;d ,street1 ,new ,york4 ,,to ,,use ,,the ,,galvanic ,,current4 ,to use the galvanic current place the ends of the conducting cords in the two binding posts marked #ac-ac4 ,place the socket of current selector 7#bj7 on the pin marked ,o1 and turn the lever of selector on pin ,no4 #a1 or on any number1 according to the number of cells desired2 at the same time see that all the switch levers are on their blank buttons1 except the one at left of current selector1 which should be on its left-hand button marked ,constant4 ,if it is desired to use cells from any other part of the series1 place the socket on the pin from which it is desired to begin1 and having previously moved the lever ahead of this pin move it along until the desired number of cells intervenes between socket and lever4 ,the number of cells in circuit when the socket is not on ,o1 but on a pin with a number1 is the difference between the number of the pin and number on which the lever rests1 for instance1 if socket is on pin #ab and lever on pin #bb1 then #aj cells are being used1 the starting point being #ab cells from any part of the series may thus be brought into the circuit4 ,if socket be placed on pin #ci and lever on pin #dj then the #djth cell would be in use only4 ,always keep the socket on the lowest number and the lever on the highest1 as putting socket ahead of lever would reverse the current4 ,should1 through any accident1 a cell become disconnected or run down1 or should it get out of order from any cause1 it is only necessary to short-circuit the cells and throw the milli-ampere-meter in circuit by adjusting the switch #aj4 ,by placing the socket on the pin marked ,o and selecting cell after cell with the lever1 the defective cell is easily found by the milli-ampere-meter failing to deflect when the pin corresponding to the defect is reached4 ,,to ,,obtain ,,the ,,interrupted ,,galvanic ,,current4 ,to obtain the interrupted galvanic current1 move the switch at left of selector on to button marked interrupted1 then turn the switch just above the vibrator on to its button marked #aa1 by adjusting the screws at #ad and #ae the proper degree of vibration will be obtained4 ,it is necessary that the point of the screws at #ae should touch the plate with every vibration as the current passes through at this point and unless it touches1 connections would not be made4 ,,to ,,measure ,,the ,,resistance ,,of ,,the ,,patient4 ,to measure the resistance of the patient turn the lever at the left of selector on to the button #h marked milli-ampere-meter and wire rheostat4 ,supposing him to have the electrodes in his hands and a current from #cj cells registers #h milli-amperes2 without changing any other conditions1 throw the upper left-hand lever #aj on button marked rheostat and milli-ampere-meter only4 ,the patient will now be thrown out and the needle will fly around as far as it can go4 ,begin by throwing in resistance1 which is done by manipulating the top row of levers1 until the needle which will have retraced its course rests directly over the division marked #h milli-amperes or whatever may have been the previously recorded amount4 ,the numbers on uncovered buttons added together will be the resistance of the patient4 ,the known resistance having taken the place of the patient4 ,the upper left-hand lever should at all times except for purposes of measuring the resistance of a patient1 be kept on its blank button1 or the battery will be short circuited and injured4 ,,the ,,pole ,,changer4 ,the pole changing lever above the two posts marked #ac-ac1 when pressed between the two right-hand springs makes the right-hand binding post positive1 and when pressed between the two left-hand springs the left-hand post becomes positive and the right negative4 ,,graphite ,,rheostat4 ,when the left-hand lever is placed on button #i it throws the graphite rheostat 7#af7 into circuit4 ,to use the rheostat first draw up the rod 7#ag74 ,by slowly pressing the rod down through the graphite it gradually lessens the resistance thereby increasing the current without shock to the patient4 ,with this rheostat you can place any number of cells in the circuit4 ,,the ,,de ,,watteville ,,switch4 ,the de ,watteville switch is placed directly above the pole changer is used for obtaining either the galvanic or the faradic current separately or the two combined4 ,when the double lever rests on figure #a and #c the galvanic alone can be used2 can when on #c and #e the faradic can be alone used and when on #b and #d the two currents are combined and used without changing the conducting cords4 ,,the ,,faradic ,,apparatus4 ,the ,faradic apparatus of this cabinet combines a fast and slow interrupter also a single contact key4 ,the style of coil used is the ,du ,bois-,raymond4 ,to use ,primary coil1 place the two tips on ends of conducting cords into the two binding posts in front of the coil1 the others being connected with any desired electrodes4 ,the strength is increased by drawing the coil to the ,right1 first placing switch at right end of coil on button marked ,p4 ,to use the secondary coil remove the tips of cords from primary posts2 then place the ends of cords in the two binding posts #ac-ac and place switch on right end of coil on button marked ,s4 ,to increase the strength of secondary1 push coil to the ,left gradually1 which is just ,opposite to what is done in case of primary current4 ,,the ,,use ,,of ,,the ,,interrupter4 ,to use the rapid interrupter which works against the end of core it is only necessary to adjust the screw ,f1 and any degree of vibration may be obtained4 ,the same may be said of the slow interrupter which is adjusted by the screw ,d1 but it is further controlled by the sliding weight at ,e4 ,by sliding the weight up and down the interruptions are varied from very slow to rapid4 ,the higher the weight the slower the interruptions and vice-versa4 ,at button ,g1 is the 8single contact0 used in obtaining single impulse contractions4 ,the different interrupters may be placed in circuit by a switch on the base of the ,cabinet which works over a series of buttons marked ,s1 ,f and ,c which put in operation the slow1 fast or single contact interrupters1 as desired4 ,,directions ,,for ,,connecting ,,cells4 ,fill the cells according to the directions on the cell label1 and connect the wires of the cable to the cells1 as shown in the cut2 ,no4 ,o being attached to zinc of the first cell1 ,no4 #a to the carbon of the first cell1 while at the same time the carbon of the first cell connected to the zinc of the second cell by strip from the carbon of cell1 ,no4 #b wire of the cable to the carbon of the second cell1 and so on1 the last wire being connected to the carbon of the last cell1 as shown by ,no4 #dj4 ,the two wires marked faradic should be connected as shown1 the four cells being placed in two rows of two each1 the zincs and carbons being connected together as shown in diagram4 99 99 99 99 99 ,transcriber's ,notes3 ,footnotes have been moved to the end of each chapter and relabeled consecutively through the document4 ,illustrations have been moved to paragraph breaks near where they are mentioned4 ,references in the text to illustrations have been standardized4 ,sidenotes originally appearing near the start of a paragraph are positioned at the beginning of the paragraph2 sidenotes in the middle of long paragraphs are positioned near the relevant sentences4 ,punctuation has been made consistent4 ,variations in spelling and hyphenation were retained as they appear in the original publication1 except that obvious typographical errors have been corrected4