B.86. Entered according to Act of Congress, in the year 1881, by HENRY C. LEA'S SON & CO. in the Office of the Librarian of Congress. All rights reserved. COLLINS, PRINTER. PAGE CONTENTS OF NUMBER 457. Galvanism, or Faradism? Which is to be Used, and When? Lecture Delivered at Jefferson College Hospital. By ROBERTS Bartho- LOW, M.D., LL.D., Professor of Therapeutics and Materia Medica in the Jefferson Medical College, Philadelphia . On the Interdiagnosis of Insensibility from Various Causes. By REGINALD SOUTHEY, M.D. Oxon., F.R.C.P., Physician to, and Lecturer at St. Bar- Galactocele; Incision; Cure. By Mr. Pearce Gould GALVANISM, OR FARADISM? WHICH IS TO BE USED, AND WHEN? A CLINICAL LECTURE DELIVERED AT JEFFERSON COLLEGE HOSPITAL, BY ROBERTS BARTHOLOW, M.D., LL.D., PROFESSOR OF THERAPEUTICS AND MATERIA MEDICA IN JEFFERSON MEDICAL COLLEGE, PHILADELPHIA. GENTLEMEN: We have had before us many cases in which the applications of electricity have been directed. Sometimes it is the galvanic, sometimes the faradic current which we employ for diagnosis or for treatment. A little inquiry will easily demonstrate, that, if we use electricity as it should be used, both kinds of batteries are necessary. In the purchase of an instrument, the buyer is sometimes misled by the statement that a particular battery furnishes all the currents-a primary or galvanic current, and the various secondary currents. A faradic instrument, of course, furnishes an induced current, and the induction exerted between the coils of the primary wire may be utilized, as well as that from the secondary wire, so that various modifications of the induced currents are available. But no one should be deluded into believing that a faradic battery can also furnish a galvanic current. Pray, do not understand me as saying that the two forms of batteries cannot be combined in the same apparatus. These may, of course, be put in one box, both faradic and galvanic combinations, and the dealers now make very beautiful and perfect instruments of this kind. I am thus minute in stating these elementary facts, because I am frequently interrogated by students and physicians in regard to these points. I start out with the declaration, then, that if you expect to use electricity in a truly scientific way, you must be provided with Loth kinds of apparatus, either separately, or combined in one box. Much may be done by faradic application alone; but in its own sphere, and if employed merely to affect the imagination of the patient, it will be quite as successful as both. I hope none here present, however, will descend to electricity quackery, whether openly or under the guise of its scientific use. As I proceed with the subject, I will indicate in passing the form of current used in particular cases. I wish also to address myself more especially to current delusions about the use of electricity. Let us take for illustration a common form of paralysis-hemiplegia. No spectacle is more often seen than the tinkering of an old hemiplegia with a faradic battery. The muscles are daily shaken up, and physician and patient are finally at their wits' end, for no improvement follows: No one, at all acquainted with the subject, would expect to benefit an ordinary hemiplegia by faradizing the muscles of the paralyzed members, unless two conditions existed: 1, wasting, degeneration, and impaired electro-contractility; 2, late rigidity. In many cases of hemiplegia, the muscles are of their normal size and firmness, and readily respond to faradic stimulation; then no good can be done by applying electricity. When late rigidityexists, the faradic and galvanic currents are useful if rightly applied. Observe the conditions present. On one side the flexors rigidly contracted, and drawing in the fingers on the palm. The nails cannot be cut, and the cast-off epidermis accumulating decomposes; ulcerations occur, and a horrible fetor is given forth. On the other side, the extensors of the fingers, relatively less powerful in the normal state, also, are now relatively weaker, and are unable to oppose the overaction of the extensors. As the galvanic current, when continuously applied, allays spasm and over-action, the flexors should have proper galvanic applications. As the extensors are weak and need stimulating, the faradic current should be applied to them. The same method of management is applicable to torticollis, or wry neck. On one side are the rigid, over-acting muscles; on the other, a group of weak or paretic muscles, quite unequal to maintain the contest with their antagonists. To galvanize and relax the one, and faradize and strengthen the other, are the obvious indications, and the successful method of treatment. In paralyses due to disease of the spinal cord both forms of currents are applicable to diagnosis and to treatment. Thus, we meet with cases in which the muscles react differently to the faradic and galvanic currents-cases in which the muscles will not respond to faradic, but will respond to galvanic stimulation. There are other examples of paralysis in which the muscular contractility to both currents is retained; and still other cases present themselves in which the response to current stimulation is impaired merely and not lost. I have already stated a fact, of which you have repeatedly seen the verification in this amphitheatre, that in ordinary hemiplegias the electrocontractility is preserved. When paraplegia, for example, is produced by disease of the dorso-lumbar enlargement of the cord, which is the centre for the nerves proceeding to the lower extremities, the power of the muscles to respond to the faradic current is presently entirely lost, but these paralyzed muscles are then found to contract to a slowly interrupted galvanic current. Further, when a paraplegia is due to disease of the cord, above the dorso-lumbar enlargement, leaving that untouched, the muscles of the lower extremities respond readily to the faradic and galvanic currents. In still other cases, say, disseminated myelitis, with lesions all along the cord, leaving tracts of healthy tissue, the muscles connected by nerve filaments to the diseased part of the cord lose their power to contract, and those muscles connected with the healthy parts of the cord retain their power to contract, on faradic stimulation. In fact, the diagnostic point is, that paralyzed members receiving their innervation from a diseased part of the spinal cord lose their electro-contractility to the faradic current, and |