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coldness has not returned, and that all that reminds her that she is not well, is a little difficulty in mounting stairs. A tenminutes seance this morning.
22d. Has had four applications since the date of last note, and is now discharged with directions to return should any relapse
The terminal branches about the ankle have not been treated at all, and here there exists a little numbness.
Dec. 13th. Writes that she is doing well, and with the exception of a little soreness occasionally by day in the calf, she regards herself as cured.
Jan. 10, 1880. Returns this morning for the reason that she has suffered pains throughout the entire limb for the past ten days. Application of galvanism, usual strength, with prompt relief.
12th. Has had no pain since the 10th. Takes thirty cells this morning; electrode from positive pole in popliteal space, and that from negative behind the external malleolus.
15th. The current was employed on the 13th and 14th, and after to-day's application the patient is finally discharged, with instructions to use the hot-water douche over the calf, should pain return.
March 5th. Reports by mail, as follows: “For ten or twelve days after the application of electricity, I suffered considerable pain, and at times was quite lame. Then the pain ceased, and I have not been troubled either night or day for four or five weeks. I have not felt as well for sixteen months.”
The case just reported in such detail, illustrates several points.
1. The value of daily applications in obstinate and chronic cases for at least a fortnight.
2. The vecessity of applying the electrodes, in turn, over every point of pain; for instance, in the popliteal space, until pain is relieved here, and then about the ankle.
3. The sedative effects on the nervous system, in promoting sleep, for instance, even when no pain is present.
4. The insignificance of relapses, after a thorough course of galvanism. There are many cases that fully illustrate this, and I feel well assured that relief aftorded in a true, uncomplicated case of sciatica, will be permanent, despite one or two slight recurring exacerbations.
This case was one peculiarly obstinate; yet the intelligence of
the patient was such as to warrant me in hoping for an ultimate
I could report another similar to this one did time permit, wherein relief did not come promptly, because of the difficulty in getting any seance long enough. After awhile though, all pain wore off, and the case, if reported in extenso, would convince the most skeptical that a direct relationship of cause and effect existed.
CASE XVII. of my list was one of pure rheumatic sciatica, and a strong current had no effect at all; in fact, the patient seemed to grow worse after each application. It was then determined to give the faradic current a trial, but he did not return. On tracing him out, several months later, it was found that he had been finally relieved after a three months' rest in bed.
Case XXXII. was treated faithfully for what seemed to be a double sciatica, with only temporary relief. This case, however, was very obscure diagnostically, and on March 24, 1879, Prof. E. C. Seguin, after a careful examination, decided that it was not a case of sciatica. The patient subsequently came under the care of my friend Dr. Putzel, and was cured by the actual cautery and aconitia. Did time permit, I should like to give the case in detail, as there are many interesting points involved.
CASE II. of my list, and already partially reported in my fornier paper, has not received any permanent benefit from a prolonged course. This patient had varicose veins as a complication, and it was supposed that this rather aggravated the sciatica, yet I must confess that I am at a loss to see how this could be. At any rate, she attended faithfully, for several weeks, and while she would get relief for a day or two, nothing permanent has been established. In view of the invariable success in the treatment of those cases, subjected to so fair a trial as this case has had, one could reasonably inter that some organic disease in connection with the nerve existel, or that a neoplasm, in the neighborhood of the nerve, and pressing upon its trunk, were present. The case demanded surgical interference, but the patient cannot be induced to enter a hospital for that purpose.
All the patients, with one exception, were lame; twenty-two were very lame, one canie on crutches; eight were slightly lame, and three or four with a crutch and a cane.
Three cases were of less than one week's standing; three were from two to four weeks' standing; two from two to four months;
thirteen, from four to eight months; two, one year; four, two years; one five years, and one six years.
Thirteen were directly traceable to exposure, three to a strain, one to injury, and in fifteen the cause could not be found. Nearly all the patients belonged to the laboring classes. A list of the occupations is quite irrelevant.
In two cases, the current was employed thirty times; in three it was employed from fifteen to twenty times; in six from ten to fifteen times; in seven from eight to ten times; two bad seven applications; three had six; three five; five four; and one had only three. The average number was ten.
The battery with which our success has been attained is the Leclanché. The ordinary Stöhrer can be employed, if there be a sufficient number of cells, i. e., twenty to forty. The usual number in the batteries on sale is eighteen or twenty.
I believe that one can the most readily combat the most severe cases of sciatica with a Leclanché. This cell consists of a glass jar, containing a solution of sal-ammoniac and water, in which both poles are placed, the positive composed of carbon, and hermetically sealed in a porous vase; the negative, of a plate or pencil of amalgamated zinc. It is not an expensive cell, and a sufficient number to make a powerful battery can be obtained for a trifle over the cost of an ordinary Stöhrer battery. The current selector can be made very simple, and will be very inexpensive. I am not describing now a fine cabinet battery. The mounting depends, of course, upon the taste of the physician.
In applying the current, let it be understood from the beginging that it must in reality be a constant current, and to insure this, be careful not to move either electrode, after it has been secured in the locality desired. The lubile current is not a constant current. Place the electrode from the positive pole directly over the soft parts, immediately under which the sciatic nerve emerges from the pelvis. This can be found by placing the thumb of the hand, corresponding to the limb affected, over the tip of the trochanter major, and the third, or middle, over the tuber ischii. Then the tip of the index finger will fall directly over the great sacro-sciatic foramen. If, now, pressure be made firmly and deeply here, there will be referred sensations in the distribution of the nerve. Should the referred sensations be uot experienced, the finger must be moved about this region until the nerve is found.
In one case we have under observation now, the nerve has a very peculiar place of exit. It seems to emerye very near the sacro-iliac synchondrosis, and the patient got no relief until this was found. It is absolutely necessary, therefore, to find the nerve, and get the electrode over its trunk. The electrode from the negative pole should be placed, as a rule, in the popliteal space, or wherever there is pain or numbness. I have indicated the descending current throughout this paper, and I have indicated purely on theory. I believe that good results are obtained with the ascending current; but I think it safer always to employ the descending. I am aware that authorities regard one about as good as the other. If the nervous centres should be specially irritable, however, I should fear some irreparable injury from employing the ascending current, and I am not sure but that those patients who are reported to have been seriously injured by electricity, are those on whom this current has been employed. I am quite sure that I have injured no patient by galvanism, however strong, and I believe it is because I have been careful always to employ the descending current. The strength of the current should depend on the sensibilities of the individual pa. tient. Let it be just as strong as can be borne, even if vesication is produced. Time and again I have been told by patients that the pain induced by the electricity was nothing to compare to that induced by the disease.
The length of time for each sitting or seance will depend, too, on the patient in a great measure. Let it, if possible, extend over ten minutes; fifteen would be better. The applications should be made every day, and, if practicable, twice a day for the first week.
Ilow many are vecessary to effect a cure? This will depend upon the duration of the sciatica and upon the severity of the same. Ordinarily for recent acute cases, from six to ten will suffice; in the chronic cases from ten to twenty. If, after twenty applications, there be no perceptible improvement, and you be fully satisfied as to the correctness of your diagnosis, then the battery had best be discontinued. One ought to get good results after two or three seances, and if no marked improvement follow five or six, the case should be examined again very carefully, and the diagnosis be fully verified.
Now, in conclusion, I do not know that I can do better than quote some concluding remarks from my former paper, read
before the New York Academy of Medicine, February 6, 1879, nd already referred to.
* With a galvanic battery the practitioner has under control one of the most obstinate and harassing of maladies. Under his observation come all the recent cases, and with a practical knowl. edge of the constant current, the neuralgia could be arrested before it becomes chronic, and at a stage of all others the most amenable to a judicious electrical treatment.”
It will be observed that I have not discussed theories as to the mode of action. I do not know how the current acts, yet it is my couviction that it acts as a nerve sedative.
In concluding this paper I wish to express my thanks to the different members of our hospital staff for valuable assistance in tracing out cases, getting ultimate results, etc. etc. To Dr. L. Emmet Holt, of the Bellevue Hospital staff, I am likewise indebted for similar assistance, and to him my thanks are likewise extended.