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Fat and Blood: Treatment of Certain Forms of Neurasthenia and Hysteria, essay(s) by S. Weir Mitchell |
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Chapter 7. Electricity |
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_ CHAPTER VII. ELECTRICITY Electricity is the second means which I have made use of for the purpose of exercising muscles in persons at rest. It has also an additional value, of which I shall presently speak. In order to exercise the muscles best and with the least amount of pain and annoyance, we make use of an induction current, with interruptions as slow as one in every two to five seconds, a rate readily obtained in properly-constructed batteries.[24] This plan is sure to give painless exercise, but it is less rapid and less complete as to the quality of the exercise caused than the movements evolved by very rapid interruptions. These, in the hands of a clever operator who knows his anatomy well, are therefore, on the whole, more satisfactory, but they require some experience to manage them so as not to shock and disgust the patient by inflicting needless pain. The poles, covered with absorbent cotton well wetted with salt water, which may be readily changed, so as not to use the same material more than once, are placed on each muscle in turn, and kept about four inches apart. They are moved fast enough to allow of the muscles being well contracted, which is easily managed, and with sufficient speed, if the assistant be thoroughly acquainted with the points of Ziemssen. The smaller electrode should cover the motor-point and the larger be used upon an indifferent area. After the legs are treated, the muscles of the belly and back and loins are gone over systematically, and finally those of the chest and arms. The face and neck are neglected. About forty minutes to an hour are needed; but at first a less time is employed. The general result is to exercise in turn all the external muscles.[25]
[Footnote 25: In the extreme constipation of certain hysterical women, good may be done by placing one conductor in the rectum and moving the other over the abdomen so as to cause full movement of the muscles. This means must at first be employed cautiously, and the amount of electricity carefully increased. It is doubtful if any movement of the intestinal muscle-fibres is thus caused, but that it is a useful method of stimulation in obstinate cases may be taken as proved.]
A half-hour's treatment of the muscles commonly gives rise to a marked elevation of temperature, which fades away within an hour or two. This effect is, like that from massage, most notable in persons liable to fever from some organic trouble, and it varies as to its degree in individuals who have no such disease. The first case, Miss B., aet. 20, is an example of tubercular disease of the apex of the right lung. She had a morning temperature of 98-1/2 deg. to 99-1/2 deg., and an evening temperature of 100 deg. to 102 deg.. Electricity was used about 11 o'clock daily, with these results:
Mrs. R., aet. 40, the next case, was merely a rather anaemic, feeble, and thin woman, who for years had not been able to endure any prolonged effort. She got well under the general treatment, gaining thirteen pounds on a weight of ninety-eight pounds, her height being five feet and one inch. The facts as to rise of temperature are most remarkable, and, I need not say, were carefully observed. Temperature taken in the mouth while at rest in bed.
The third case, Miss M., aet. 33, was that of a pallid woman, the daughter of a well-known physician in the South. She suffered for six years with "nervous exhaustion," headaches, pain in the back, intense depression of spirits, nausea, and repeated attacks of hysteria. She slept only under anodynes, and used stimulants freely. Under the use of rest and the adjuvant treatment described, Miss M. made a thorough recovery, and was restored to useful active life. Miss M. Thermometer held in mouth.
Mrs. P., aet. 38, was a rather nervous woman, easily tired, but not anaemic and not very thin. She improved greatly under the treatment.
Miss R., aet. 27, was a fair case of hysterical conditions; over-use of chloral and bromides; anorexia and loss of flesh and color. Thermometer in mouth.
I have given these full details because I have not seen elsewhere any statement of the rather remarkable phenomena which they exemplify. It may be that a part at least of the thermal change is due to the muscular action, although this seems hardly competent to account for any large share in the alteration of temperature, and we must look further to explain it fully. No mental excitement can be called upon as a cause, since it continues after the patient is perfectly accustomed to the process. I should add, also, that in most cases the subject of the experiment was kept in ignorance of the fact that a rise of the thermometer was to be expected. Is it not possible that the current even of an induction battery has the power so to stimulate the tissues as to cause an increase in the ordinary rate of disintegrative change? Perhaps a careful study of the secretions might lend force to this suggestion. That the muscular action produced by the battery is not essential to the increase of bodily heat is shown by the next set of facts to which I desire to call attention. Some years ago, Messrs. Beard and Rockwell stated that when an induced current is used for fifteen to thirty minutes daily, one pole on the neck and one on either foot, or alternately on both, the persistent use of this form of treatment is decidedly tonic in its influence. I believe that in this opinion they were perfectly correct, and I am now able to show that, when thus employed, the induced current causes also a decided rise of temperature in many people, which proves at least that it is in some way an active agent, capable of positively influencing the nutritive changes of the body. The rise of temperature thus caused is less constant, as well as less marked, than that occasioned by the muscle treatment. I do not think it necessary to give the tables in full. They show in the best cases, rises of one-fifth to four-fifths of a degree F., and were taken with the utmost care to exclude all possible causes of error. The mode of treatment is as follows: At the close of the muscle-electrization one pole is placed on the nape of the neck and one on a foot for fifteen minutes. Then the foot pole is shifted to the other foot and left for the same length of time. The primary current is used, as being less painful, and the interruptions are made as rapid as possible, while the cylinder or control wires are adjusted so as to give a current which is not uncomfortable. It is desirable to have electricity used by a practised hand, but of late I have found that intelligent nurses may suffice, and this, of course, materially lessens the cost. In very timid or nervous people, or those who at some time have been severely "shocked" by the application of electricity in the hands of charlatans, it is common to find the patient greatly dreading a return to its use. In this case, if the battery be started and the poles moved about on the surface as usual, but without any connection being made, one of two things will happen,--either the patient will naturally find it very mild, and will submit fearlessly to a gentle and increasing treatment, or else her apprehensions will so dominate her as to cause her to complain of the effects as exciting or tiring her, or as spoiling her sleep. A few words of kindly explanation will suffice to show her how much expectation has to do with the apparent results, and she will be found, if the matter be managed with tact, to have learned a lesson of wide usefulness throughout her treatment. However, there are occasional, though very rare, cases in which it is impossible to use faradism at all by reason of the insomnia and nervousness which result even after very careful and gentle application of the current. On the other hand, some patients find the effect of the electric application so soothing as to promote sleep, and will ask to have it repeated or regularly given in the evening. I have been asked very often if all the means here described be necessary, and I have been criticised by some of the reviewers of my first edition because I had not pointed out the relative needfulness of the various agencies employed. In fact, I have made very numerous clinical studies of cases, in some of which I used rest, seclusion, and massage, and in others rest, seclusion, and electricity. It is, of course, difficult, I may say impossible, to state in any numerical manner the reason for my conclusion in favor of the conjoined use of all these means. If one is to be left out, I have no hesitation in saying that it should be electricity. _ |
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