This section is from the book "A Treatise On Therapeutics, And Pharmacology Or Materia Medica Vol1", by George B. Wood. Also available from Amazon: Part 1 and Part 2.
This generally assumes the form of hemiplegia; but it may also be paraplegic or local. The reader will bear in mind the observations above made, in relation to the circumstances under which electricity becomes applicable in this affection. No attempt should be made to employ this agent, until there is reason to think that the effused blood has been absorbed, and a cyst or cicatrix only remains, without inflammatory action. It will seldom be proper to begin with the use of it until six or seven months after the commencement of the disease. If employed too early, there will be great danger of producing hazardous congestion or inflammation of the brain, through the reaction upon it of the local disturbance. To obviate this as far as possible, the excitors should be placed as near each other as may consist with the object of sending the current into the muscle, so as to confine the disturbance within the narrowest limits. If, in cases of cerebral hemorrhage, after from five to eight months, the palsy persists without any contraction of the muscles, a cure may be expected with considerable certainty under faradisation; if there be permanent contraction, little hope of a cure need be indulged; as this condition indicates a persistent state of cerebral inflammation or softening, which is not likely to cease.* If there be only temporary, or irregular contractions, the prognosis is less favourable than with none, but not altogether unfavourable; as this condition may be owing to an unhealthy excitability of the spinal centres, consequent on a diminution of cerebral power. Nor must the mere stiffening of a muscle, arising from it The two electrodes act differently on the blood-vessels; the positive dilating them and reddening (he skin, the negative producing a contrary effect, after continuing from five to ten minutes in action.
* Dr. Robert Remak, of Berlin, asserts, as the result of numerous trials, that the application of the continued current, as produced by the elements of Daniell, Grove, and Bunsen. has the effect of immediately relaxing the tonic spasms of the muscles attending hemiplegia from cerebral hemorrhage, and rendering them amenable to the action of the will. He affirms, too, that by the continued application of the constant current to the nerves and muscles, he has obtained curative effects greater than he had been able to obtain by any other mode of applying electricity, in acute and chronic rheumatism, cerebral hemiplegia, paraplegia, muscular atrophy, chorea, stammering, trembling of the limbs, and cramps. (Med. Times and Gaz., May, 1858, p. 479.) - Note to the second edition.
The late Berlin Professor, Dr. Robert Remak, referred to in the preceding note, was one of the highest German authorities on the subject of medical electricity, and the great advocate for galvanization, or the use of the constant current as a therapeutic agent, in contradistinction to the induced or interrupted current, the faradisation of M. Duchenne. Shortly before his decease, he delivered a course of lectures at the Hospital "La Charite," of Paris, setting forth his peculiar views, a translation of which is published in the New York Medical Journal for June, July, and August, 1866 (pp. 185, 279, and 357). The following are some of the more interesting points, which I have thought it due to the subject of electrical therapeutics to place before the readers of this work. The constant galvanic current is, according to Prof. Remak, incomparably superior, in the treatment of diseases, to all other electrical currents; and, in the majority of instances where this is useful, the induction currents are rather injurious than otherwise. He appears to prefer, for the development of galvanism, the battery of Daniell, which affords a more constant current than that either of Grove or of Bunsen, and the objection to which, of requiring daily cleansing, has been obviated by recent improvements. He applies the current to the surface by means of metallic electrodes covered with muslin or wool, moistened with water, which communicate with the conducting rods by a bundle of silver wires, with gutta percha or caoutchouc envelopes (p. 188). He prefers the surface of application of those instruments to be as broad as circumstances will admit; but it of course must vary in size according to the part to which it is applied.
The general effect of a prolonged application of the constant current is increase of the temperature of the body, followed by perspiration, and often a long sleep and subsequent general feeling of repose. Of the local effects the most curious are those upon the special senses, which are not produced by the induction current. Thus, a very feeble current applied to the face occasions flashes of light, and a peculiar modification of taste. Though, in a healthy state of the organ of hearing, little effect is produced; yet, in nervous deafness, the gentlest application of the current to the petrous bone causes sounds. The retina is most sensitive to the positive pole, the gustatory nerves to the negative; and the auditory nerve is more sensitive at the opening of the circuit than at its close. Another effect of the constant current is a species of vertigo, which is apt to happen when the application is made to a certain limited space, as in the auriculo-maxillary fossa. A descending current acts more energetically on the nerves of sensation, an ascending on those of motion; the former at the point of exit, the latter at that of entrance.
Dr Remak makes a distinction between the constant and the continuous currents. The voltaic pile may give a continuous current, but it is not steady, and gradually weakens until it ceases at last; the constant current continues long without losing its intensity. The constant current does not require that the electrodes should be in immovable contact with the skin; but is developed equally by passing the electrodes over the surface from point to point, without separating them from the body. These currents are distinguished as the current in repose and the current in motion, the former proceeding from the unmoved electrode, the latter from the one changing its position. As to the visible effects of the electrodes on the skin, the negative pole rather than the positive, produces a papillary and urticarious eruption, often extremely sensitive, and, after prolonged application, becoming filled with fluid, and ending at length in a brown crust.
In general the current in repose is calming, and the current in motion exciting: yet. in severe paralysis, the former, when not too much prolonged, is more energetic in restoring power than the latter. Generally, interruptions in the constant current weaken it, and are useful only in the treatment of contracted muscles. The soothing influence of the constant current is exerted by very feeble galvanic action, insufficient even to disturb the skin. It differs from the sedative influence of the narcotics, as opium, belladonna, etc., and should not supersede them; but when these fail to yield prompt relief, and in cases requiring their long-continued use, galvanization should be resorted to, which both soothes and stimu-The soothing influence may be employed to relieve exaggerated sensibility in a part, the result of inflammation. Under such circumstances, the positive electrode may be applied over the painful part, the negative at a distance. A battery of from 15 to 25 elements will generally give relief in from 5 to 20 minutes. But the most effective plan, which relieves the severest inflammation and most exquisite sensitiveness, is to place the positive electrode on some point of the nerve-trunk which is distributed to the diseased part, and the negative anywhere else.
Dr. Remak mentions as a curious fact, that, in the treatment of neuralgia, the direct application of the constant current to certain points of the nerve-centres having no relation with the limb or part affected, is often very effectual. This, however, may be considered as an example of revulsion, analogous to the powerful influence of mental emotion in relieving neuralgia.
The constant current is radically curative only where it reaches the source of the disease; for example, when it acts on and removes the inflammatory swelling of the nervous sheath, on which neuralgia may depend.
In the treatment of paralysis, whether of motion or sensation, the galvanic current will exhibit its anti-paralytic power only when any disease in the nervous centres or trunks in which the paralysis originated has ceased. Then the constant current, sent through the negative electrode, to the nervous filaments supplying the paralyzed muscle, will instantly render the muscle subservient to the will. But to effect a perfect cure, it will be necessary to apply the current several times, shortening by position, be confounded with tonic spasm or rigidity. M. Duchenne effected radical cures in one-twentieth only of the cases, and amelioration in about one-quarter. The probability, I think, is that the electricity does not operate altogether locally, in these cases, in restoring voluntary contractility; but that the excitement produced in the muscle, also reacts usefully as a stimulant upon the cerebral centres.
It may sometimes be very important, in deciding as to the proper period for commencing with the electric treatment, to know certainly whether the affection is really cerebral. The complete integrity of the electro-muscular contractility in the paralyzed muscle, which characterizes the cerebral cases, might be sufficient sometimes to determine the question.
When palsy of the face and tongue only is left after the absorption of the effused blood, it will in general readily yield to this remedy; but it should be employed, at first, with much caution, for fear of involving the brain, from its vicinity.
Indeed, it would be a good rule, in reference to cerebral palsy in general, to commence cautiously, with short sittings of not more than five minutes, and not repeated oftener than every second or third day, until the state of the brain shall have been sufficiently tested. The intermissions, too, should be distant, as exciting less disturbance of sensation, which is most to be apprehended; while the contraction produced is energetic. The influence should be directed to every paralyzed muscle; and those most deeply affected should be longest and most strongly excited.