Herbert Tibbits

“ In the daily use of a battery the chief work is usually thrown upon the first half (say in a battery of forty cells, upon the first twenty-five) , and various arrangements have been added to batteries by ingenious instrument-makers to enable the operator to vary his selection of the cells to be brought into use, and thus to relieve the first half of his battery, or, in other words, to equalize its work. But this unequal work question is more a theoretical than a practical evil; for if the initial cells grow weaker a greater number can be placed in use. ”

“ On the contrary, everything is made so clear that any practitioner, whether he previously knew anything of electricity or not, may from this book at once begin the practical use of it, and if there are any lingering doubts in the minds of some ultra-conservative persons as to the practical value of electrical treatment, this book should dispel them.... the busiest practitioner can, without difficulty, learn how to effect a large amount of good which he was previously quite unable even to attempt.”—The Practitioner. ”

“ It is a comforting theory to electro-therapeutists that a galvanometer will enable them to administer their doses of electricity with as much exactitude as we daily prescribe so many grains, or so many minims of ordinary medicines; but, like some other theories which save us much trouble, when adopted as theories only, it fails us in practice (at least according to my experience) , and chiefly so, because a galvanometer can be usefully employed only when it is included in the circuit of a continuous current, as, e.g., in aneurismal electro-puncture ”

“ Electricity will be left in the hands of specialists, and necessarily do but a tithe of the good it is capable of affecting, until the mass of the profession can be induced to master the few preliminary details essential to its successful application, and I fear that the suggestions that have been made—suggestions which I believe to be entirely without foundation—that there exist practical difficulties to its dosage, will tend to postpone rather than to accelerate its more extended use. ”

“ General effects of Electrization.
So much for the general effects of electricity. All the structures of the body respond to its application; the muscles and motor nerves, as we have seen, by contraction; the nerves of common sensation by a burning or pricking; and of the nerves of special sense; the retina by a flash of light; the auditory nerve by a sound; the olfactory nerve by a peculiar smell; and the gustatory by a metallic taste, differing at the two poles. ”

“ We have now brought the electricity to the terminals of our battery, and we must next consider the best means of conveying it to the sponges, conductors, or, as they are generally termed, rheophores or current carriers, by which it is finally applied to our patient.|Conducting Cords.| Our first necessary accessory is a conducting cord or wire, and it is of the first importance that this should really be what it is called—“a conductor”—for any fault or break of connection in it will, of course, nullify the best and most perfect battery. ”

“ This work fills up a hiatus in the literature of medical electricity. It purposes to teach (to use the words of the preface) ‘the busy practitioner not only when to use electricity, but in explicit and full detail how;’ and in ‘moderate bulk to contain only what it is essential to master.’ Dr. Tibbits’ object has been to give the results of the best work, and to this end he has availed himself freely of the large experience of the Electrical Room of the National Hospital for the Paralysed and Epileptic.
“The work is what it professes to be, and is a handbook in the best sense of the work. ”

“ If, in our examination of the muscle, we find irritability normal to both currents, we have proof of the integrity of the muscular tissue. If the muscle also responds by contraction to electrization of its nerve, we have further proof that the nerve is healthy, and also the spinal cord at the point of origin of the nerve.|Electro-Irritability diminished.| If we find the irritability lessened, there is disease of either muscular tissue, nerve or cord ”

“ A convenient method of applying electricity, when very strict localization is not required, is to insert the feet and hands of the patient, or one foot and one hand, as the case may be, in separate vessels containing tepid salt and water with which the conducting wires of the battery are in contact, the current being allowed to circulate during the time required. Ordinary foot-pails, basins, or jugs, will fulfil every requirement; while thick telegraph wire answers well to connect the battery with the vessels of water, as it is little liable to break and wears well. ”

“ The almost complete absence in the medical schools of the great hospitals of opportunities for an adequate study of electro-therapeutics, the importance of the subject, and the widespread attention that it is awakening throughout the profession, have also determined me to sketch as briefly as is consistent with clearness the present position of the science and practice of medical electricity, and especially of its practice. [3]
Electricity, Gentlemen, is by no means one of those remedies that, failing to do good, is little likely to do harm. ”

“ Under such circumstances it is especially imperative, for there is great belief, even with educated persons who ought to know better, that the benefit derived from electrization is in exact proportion to the pain given by it, and a little personal experience is a very wholesome corrective to such a notion. Graduate your dose, then, by the number of cells employed checked by testing its effect, and do this upon each application, for there is no certain means of securing that the strength of either a Voltaic or a Faradaic current shall not have varied from day to day. ”

“ When in any form of paralysis ANY amount of voluntary power has been restored by electricity, it is most important that the patient should be encouraged to use the limb and practise various movements. Passive movements are of equal importance, and the paralyzed muscles should be frequently exercised by this mode to the fullest extent of their normal movements. ”

“ The Voltaic current is a continuous current. Unless artificially interrupted, the electricity flows in an unbroken stream until the battery is exhausted. The current will gradually lessen in power until it ceases, but there will be no break in it, and no change in its direction, which is uniformly from the positive to the negative pole. |Points of distinction between the Voltaic and Faradaic Currents.| It is important to recollect these points, for they constitute the chief physical distinction between the Voltaic and the Faradaic—or, as it is sometimes called, the Induced current. ”

“ We must satisfy ourselves that the current from our battery is also constant, and that we so apply it to our patients that the affected nerve shall be—as it is called—included in the circuit—that is, between the poles, and that the current circulates through this nerve as perfectly and continuously as it would through a piece of wire connecting the terminals of the battery. ”

“ There are certain forms of paralysis affecting children where the muscles are rigid. Localization of any form of electricity in these rigid muscles is quite useless; but if these cases depend upon adhesions or exudations into the medulla their absorption may possibly be promoted by localizing a Voltaic current in the superior cervical ganglia of the sympathetic; two small conductors, leather, tipped and well-moistened in connection with the poles of a Voltaic battery being applied for four or five minutes to the bottom of the auriculo-maxillary fossæ on both sides. ”

“ As it is one of our objects in our practice here to study the scope and the limits of electricity as a remedy in disease, it seemed to me not inappropriate to devote my first Lectures to electro-therapeutics; and the more so, as few medical men have a practical knowledge of the subject ”

“ In non-atrophic paralysis—of which hemiplegia may be taken as a type—the propriety of electrization, and especially the proper moment for its application, requires careful consideration. In both brain and spinal cord disease muscular electrization is not advisable until some time after the attack, or until the muscles exhibit signs of impairment of nutrition from disuse. As long as there is rigidity—especially with increased [86] reflex action—any stimulant application of electricity is not likely to do good, and may do harm ”

“ The innovation I have made consists in limiting the primary coil to its legitimate purpose of induction, and rendering the secondary alone available for application to a patient. I have been long satisfied that therapeutically the distinction between the primary and secondary coil entirely consists in the greater tension of the current of the secondary coil enabling it to penetrate easily several thicknesses of muscle, but there is no therapeutic indication that cannot be fulfilled by this secondary coil ”

“ We will next consider cutaneous electrization. I have already shown you that when the skin and the conductors are both quite dry, a Faradaic current of moderate power (and practically this form of electricity is always employed in cutaneous electrization) does not penetrate the skin, but is localized upon its surface. ”

“ The action of the Voltaic current upon the brain is exceedingly powerful, and the greatest care must be exercised when it is applied to any part of the head or face. Not more than two or three cells should be commenced with. Its effect should be noted, and any increase should be made gradually. With a very moderate current giddiness is produced, and upon the sudden application of a [80] sufficiently powerful one the patient falls down as if struck by a blow. ”

“ In our first Lecture we studied the different kinds of electricity employed in medicine, and the construction and management of batteries. I reminded you that we made use of three kinds of electricity; firstly, of friction or static electricity, Franklinism; secondly, of the electricity of chemical action, Voltaism, or Galvanism; and, thirdly, of induced electricity, Faradism:—that there had been certain difficulties in the employment of Franklinism, but that these difficulties no longer existed ”

“ Electricity is coming into use in mental diseases. Faradism, and especially cutaneous irritation with the wire brush, would seem to be most suitable for cases accompanied by depression or torpor, the stimulating effects being of service in inspiriting the patient, while the soothing influence of a direct application of the constant Voltaic current to the brain may be employed in cases of over-excitement requiring a sedative. ”

“ Efficient cells are, however, but a first step to the perfection of electrical apparatus, and the mechanism by which the current is brought into use and graduated, and the general accessories of the instrument, are of at least equal importance. ”

“ The conducting cords sold by instrument-makers are sometimes not insulated at all, and then they are quite useless, but they are more commonly composed of several strands of metallic wire of about the diameter of sewing thread, the whole enclosed in some silken or woollen material, and nothing can be better than these latter when quite new. Their disadvantages are that they become frayed after a little use, and are liable to be constantly out of order, causing interruptions in the current, while they will only fit one kind of machine. ”

“ Assume the case to be an example of severe post-partum hæmorrhage, that the ordinary resources of medicine have failed the obstetrician, and that he fears every moment may be his patient’s last, but he has an induction instrument at hand. ”

“ The daily application of the positive pole for about five minutes, and with from ten to fifteen cells, to the painful spot—the negative pole being held to an indifferent part of the body—is likely to promote absorption. At any rate it will sometimes relieve the pain. In the later stages of paraplegia, as soon as there is diminution of electro-irritability in the paralyzed muscles they should be sponged with the Voltaic current, or Faradized; and where anæsthesia is present, a good painting with the wire brush will often be of service. ”

“ Radcliffe believes that an administration of positive Voltaic electricity, somewhat analogous to the charge of Franklinic electricity, is frequently beneficial. He insulates the patient and the accessories, and having connected the negative pole with the earth by a wire which he calls a “ground-wire,” he allows the current to pass. With careful insulation the negative electricity passes away by the wire, and while the current circulates the patient continues “charged” with positive electricity. ”

“ As soon as the medical attendant is summoned—and this is frequently only because the parents have noticed that the child is lame—he should carefully examine the muscles electrically, and unless there are head symptoms present, and this is very seldom, he should electrize each muscle daily with that current to which it responds, and of a strength just sufficient to produce muscular contraction. If the powerless muscles have preserved their Farado-contractility it may be confidently predicted that they will rapidly recover ”

“ Duchenne’s two test experiments, demonstrating the fundamental principles of his method, I will now repeat upon the posterior surface of my left forearm. I propose to arrest Faradism in the skin, without allowing it to stimulate the subjacent muscles. To do this it is necessary for the skin to be quite dry—moisture, as you know, being a conductor of electricity—and to make sure of sufficient dryness, I sprinkle the skin with a little starch powder. I now apply to the dry skin the dry metallic conductors of an induction instrument in action. ”

“ The Faradaic current, thoroughly localized in the uterus, will always produce its contraction, not only while life persists, but even for a limited time after death, but failure in localizing electricity in an organ, withdrawn from sight and covered with thick muscular tissue, is especially liable to occur, unless the details of application are conducted with extreme care. ”