Page:EB1911 - Volume 09.djvu/267

Rh patient’s clothing over the spine or other part to be treated. The clothing must be dry and of wool, and each additional woollen layer intensifies the effect.

Another method of employing electricity at high potential is by the employment of high frequency currents. There are two methods of application: that in which brush discharges are made use of, with undoubtedly good effects in many of the diseases affecting the surface of the body, and that in which the currents of the solenoid are made to traverse the patient directly. The physiological value of the latter method is not certain, though one point of interest in connexion with it is that whereas statical applications raise the blood pressure, high frequency applications lower it. It has been used in the case of old people with arterio-sclerosis, and the reduction of blood pressure produced is said to have shown considerable permanence.

The Faradic Current.—G. B. Duchenne was the first physician to make use of the induced current for treatment, and the term “faradization” is supposed to be due to him. But in his day the differences between the two currents available, the primary and the secondary, were not worked out, and they were used somewhat indiscriminately. Nowadays it is generally accepted that the primary current should be used for the stimulation of deep-lying organs, as stomach and intestines, &c., while the secondary current is employed for stimulation of the limb muscles and the cutaneous sensory nerves. The faradic current is also used as a means of diagnosis for neuro-muscular conditions. When the interrupted current is used to stimulate the skin over a motor nerve, all the muscles supplied by that nerve are thrown into rapid tetanic contraction, the contraction both beginning and ceasing sharply and suddenly with the current. This is the normal reaction of the nerve to faradism. If the muscle be wasted from disuse or some local cause unconnected with its nerve-supply, the contraction is smaller, and both arises and relaxes more slowly. But if the lesion lies in the nerve itself, as in Bell’s palsy, the muscles no longer show any response when the nerve is stimulated, and this is known as the reaction of degeneration in the nerve. It is usually preceded by a condition of hyperexcitability. These results are applied to distinguish between functional paralysis and that due to some organic lesion, as in the former case the reaction of faradism will be as brisk as usual. Also at the beginning of most cases of infantile paralysis many more groups of muscles appear to be affected than ultimately prove to be, and faradism enables the physician to distinguish between those groups of muscles that are permanently paralysed owing to the destruction of their trophic centre, and those muscles which are only temporarily inhibited from shock, and which with proper treatment will later regain their full power. In the testing of muscles electrically that point on the skin which on stimulation gives the maximum contraction for that muscle is known as the “motor point” for that muscle. It usually corresponds to the entry of the motor nerve. Faradic treatment may be employed in the weakness and emaciation depending on any long illness, rickets, anaemia, &c. For these cases it is best to use the electric bath, the patient being placed in warm water, and the two electrodes, one at the patient’s back and the other at his feet, being connected with the secondary coil. The patient’s general metabolism is stimulated, he eats and sleeps better and soon begins to put on weight. This is especially beneficial in severe cases of rickets. In the weakness and emaciation due to neurasthenia, especially in those cases being treated by the Weir Mitchell method (isolation, absolute confinement to bed, massage and overfeeding), a similar faradic bath is a very helpful adjunct. In tabes dorsalis faradic treatment will often diminish the anaesthesia and numbness in the legs, with resulting benefit to the ataxy. Perhaps the most beneficial use of the faradic current is in the treatment of chronic constipation—especially that so frequently met with in young women and due to deficient muscular power of the intestinal walls. In long-standing cases the large intestine becomes permanently dilated, and its muscular fibres so attenuated as to have no power over the intestinal contents. But faradism causes contraction at the point of stimulation, and the peristaltic wave thus started slowly progresses along the bowel. All that is needed is a special electrode for introduction into the bowel and an ordinary roller electrode. The rectal electrode consists of a 6-inch wire bearing at one end a small metal knob and fitted at the other into a metal cup which screws into the handle of the electrode. The only part exposed is the metallic knob; the rest is coated with some insulating material. The patient reclines on a couch on his back, the rectal electrode is connected, and having been vaselined is passed some three inches into the rectum. A current is started with the secondary coil in such a position as to give only an extremely weak current. The roller electrode is then wetted with hot water and applied to the front of the abdomen. At first the patient should feel nothing, but the current should slowly be increased until a faint response is perceptible from the abdominal muscles. This gives the required strength, and the roller electrode, pressed well into the abdominal wall, should very slowly be moved along the course of the large intestine beginning at the right iliac fossa. Thus a combination of massage and faradic current is obtained, and the results are particularly satisfactory. Treatment should be given on alternate days immediately after breakfast, and should be persevered with for six or eight weeks. The patient can be taught to administer it to himself.

The Galvanic, Continuous or Direct Current.—In using the galvanic or direct current the electrode must be covered with padded webbing or some other absorbent material, the metal of the electrode never being allowed to come in contact with the skin. The padding by retaining moisture helps to make good contact, and also helps to guard against burning the skin. But when a continuous current of 3 am. or more is passed for more than 5 min. the electrodes must be raised periodically and the skin inspected. If the current be too strong or applied for too long a time, small blisters are raised which break and are very troublesome to heal. Nor does the patient always feel much pain when this occurs. Also the electrodes must be remoistened every five or six minutes, as they soon become dry, and the skin will then be burnt. It is best to use a solution of sodium bicarbonate. Again, the danger of burning the skin depends on the density of the current per sq. in. of electrode, so that a strong current through a small electrode will burn the skin, whereas the same current through a larger electrode will produce a beneficial effect. If the patient be immersed up to his neck in an electric bath, much stronger currents can be passed without causing either pain or injury, as in this case the whole area of the skin in contact with the water acts as an electrode. In passing the current it must be remembered that the negative electrode or kathode is the more painful of the two, and its action more stimulating than the positive electrode or anode, which is sedative. If a muscle be stimulated over its motor point, it will contract with a sharp twitch and then become quiescent. With normal muscle the KCC (kathodal closure contraction) is stronger than that produced by the closure of the current at the anode ACC (anodal closure contraction). And if the muscle be normal the opening contraction KOC and AOC are not seen. When a galvanic current is passed along a nerve its excitability is increased at the kathode and diminished at the anode. The increased excitability at the kathode is katelectrotonus, and the lowered excitability at the anode anelectrotonus. But since in a patient the electrode cannot be applied directly to the nerve, the lines of force from the electrode pass into the nerve both in an upward and downward direction, and hence there are two poles produced by each electrode. If the current be suddenly reversed, so that what was the anode becomes the kathode, a stronger contraction is obtained than by simply making and breaking the current. To avoid the four poles on the nerve to be tested, it is found most satisfactory to have one electrode placed at some distance, on the back or chest, not on the same limb.

As explained above, when the nerve supplying a muscle is diseased it no longer responds to the faradic current. On further testing this with the galvanic or continuous current it responds, but the contraction is not brisk but begins slowly and relaxes