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this is attributed to pressure exerted upon the nerves, this cannot be the case where the paralysis occurs at an early period of pregnancy or after the birth of a child with a head that is too small to exercise any considerable pressure upon the lumbar plexus. Moreover, the nervous origin of these palsies must be rejected when the paralysed muscles do not correspond to the nerves that may be thus compressed. The author brings forward the authority of Lobstein and Virchow to prove that the violent muscular efforts during labour may give rise to inflammation of the muscles; he forgets, however, that the paralysis he speaks of does not occur in the muscles that are most ilhplicated, those of the abdomen, but in those of the lower extremities, which are not more taxed than the muscles of respiration during the act. Rickets, osteomalacia, and lead-poisoning are also examined in reference to their capability of producing muscular palsy.
5. Myojyathia Marasmodes.—This term is intended to define the variety of degenerative disease of the muscles resulting from the absence of one of the three constituents of healthy muscle, the due alternation of expansion and contraction, the necessary supply of blood, and the requisite innervation. Myopathia is not necessarily caused by deficient exercise of the muscles, but occurs when this element of disease exists and is accompanied by other morbid tendencies in the muscle; firm bandages, splints, and other applications may act thus if too great pressure is used, which interferes with the nutrition of the muscle; the diseased condition of the muscles results invariably when the joints remain immovable in consequence of organic changes, a process which being altogether secondary, and one that only affects the organs of motion because they can no longer be put to their normal uses, is as much physiological as pathological; similar conditions will readily suggest themselves to our readers, in which loss of function entails loss of structure. Defective supply of blood acts as an inducing cause in the wasting of old age, in the nutritive changes of the muscles accompanying disease of the vessels or their obliteration, and resulting from the pressure exercised by tumours.
Thus in a lady, who had suffered for several years from severe pains and complete motor paralysis of the lower extremities, though the adipose tissue of the body was much developed, the muscles of the legs universally presented fatty degeneration; some were atrophic, others, owing to the deposit of more fat, were found by Dr. Friedberg to have increased in volume. The abdominal aorta from below the point at which the inferior mesenteric artery was given off, was considerably diminished in size, the parietes thickened, and exhibiting extensive atheroma and chalky deposit. The various branches showed a similar morbid condition. For cases illustrative of the other varieties we must refer to the work itself. We pass to the consideration of the sixth and last form of the disease.
6. Myopathia simplex is defined by the author as that variety which occurs without known cause, and which may attack numerous sets of muscles, or be confined to single muscles. These, according to Dr. Friedberg, are the cases which are ordinarily regarded as paralytic affections of individual nerves. From this point of view, he criticises several cases reported by authors, of which we may specially mention one, because readily accessible to our readers. Professor Romberg, in his work on the nervous diseases* of man diagnosed in a woman, aged 69, paralysis of the hypoglossus; the whole tongue was uniformly paralysed and atrophied, while taste and sensibility remained unimpaired. Our author argues that Romberg's view regarding the nature of this woman's disease must be erroneous, because many of the muscles that receive filaments from the hypoglossi did not mauifest any paralytic affection, and he regards the lingual palsy only as a part of a more wide-spread degeneration of the muscles of the neck and thorax.
In determining the treatment of myopathic paralysis we must, as the author justly observes, consider the restoration of the normal nutrition of the muscles as the chief indication. The result will be more or less favourable, according to the
• Dr. Bleveking B translation, vol. ii. p. 807.
period of the disease at which curative proceedings are commenced. The intensity of the degenerative process, the number of muscles affected, and the cause of the disease, will modify the prognosis. An hereditary taint materially adds to the difficulties and diminishes the prospect of cure. The treatment itself is indicated by the pathology of the affection. Where acute inflammatory symptoms continue antiphlogistic remedies will be necessary; but though Dr. Friedberg gives this advice, in order that he may be consistent with his theory regarding the cause of the affection, he makes little of it, and at once adds the caution not to pursue the antiphlogistic course as soon as the inflammation has entered into the chronic stage. We lay more stress upon the remark that "the chief remedy for the protracted nutritive disturbance of the muscle consists in stimulating it methodically to contract." Contraction of the muscle promotes its nutrition by rousing the circulation, and thus counteracts the degenerative process. Electricity and suitable gymnastic exercises are specially adapted to cause muscular contraction. Both should be used perseveringly and systematically to produce a good result. The former especially requires to be administered with care and with a due knowledge of the object to be attained, and of the parts to be acted upon. The current may be applied either directly to the muscles affected, or it may be conveyed to them by application of the negative pole to the nerve going to the muscle, while the positive electrode is applied to the distal termination of the muscle. The second method is more suitable where a set of muscles is to be acted upon, the first where we desire to stimulate the individual muscle. The electric or galvanic agent must be supported by friction and active and passive movement varied and increased according to the patient's condition.
The work concludes with some remarks on the mode of counteracting and removing contractions of joints resulting from muscular degeneration, but which need not detain us.
In bringing this account of Dr. Friedberg's labours to a close, we do not hesitate to recommend his work to our readers. His facts and arguments deserve to be studied, and, although we have been unable to coincide with him on all points, we have perused his book with much interest, and regard it as eminently suggestive and practical. If a second edition should be called for, we think that the treatment of the subject may be much simplified, and especially does it appear to us that some confusion would be avoided by clearly distinguishing between those cases of muscular degeneration which are primary or idiopathic, and those which are secondary or symptomatic.
1. Traite des Applications de P Electricite d la Therapeutique Medicale et Chirurgicale. Par A. Becquehel, Medecin de l'Hopital de la Pitie, &c.—Paris, 1857.
Treatise on the Application of Electricity to Medical and Surgical Therapeutics. By A. Becquerel.—Paris, 1857.
2. Die Electricitat in der Median. Studien von D. Hugo Ziemssen. PrivatDocent und Assistenz-arzt an der Medicinischen Klinik zu Greifswald. Berlin, 1857.
Electricity in Medicine. Studies by Dr. Hugo Ziemssen.—Berlin, 1857.
3. Veber das Ilemmungs-Neroen-System filr die peristaltischen Bewegungen der Geddrme. Von Dr. Edward Pfluger.—Berlin, 1857.
Upon the Inhibitory Nervous-System for the Peristaltic Movements of the Intestines. By Dr. Edward Pfluger.—Berlin, 1857.
4. Preliminary Account of an Inquiry into the Functions of the Visceral Nerves,
with special reference to the so-called "Inhibitory System." By Joseph Lister, F.R.C.S., Eng. and Edin. (' Proceedings of the Royal Society of London; vol. ix. No. 32.')
5. Epilepsy and other Convulsive Affections, their Pathology and Treatment. By Charles Bland Radcliffe, M.D., F.R.C.P. Preliminary Considerations respecting the Physiology of Muscular Motion.—London, 1858.
6. Ueber Methodische Electrisirung geldhmter Muskeln. Von Dr. R. Resiae.— Berlin, 1845.
Upon Methodical Electrification of Paralysed Muscles. By Dr: Remae. (Revised by Duchenne, m Schmidt's 'Jahrbtlcher, 1856. Bd. 89. p. 250.')*
7. On the Therapeutical Action of the Constant Galvanic Current. By Dr. Robert Remae. (' Medical Times and Gazette, May 8, 1848.')
8. Bericht ilber medicinische Electricitat. Von Dr. H. E. Richter, nnd Dr. B. A. Godmann. («Schmidt's Jahrbticher, Bd. 94, Heft i. p. 97.')
Review of Medicinal Electricity. By Drs. Richter and Godmann.
9. Recherches Experimentales sur la Possibility du Passage a tracers le Centre
Nerveux, de Courants Electro-Magnetiqiies appliques d la Peau, chez PLTomme. Par M. F. Bonnefin. ('Journal de la Physiologie, tom. i. No. 3.') Experimental Researches upon the possibility of Passing Electro-Magnetic Currents through the Nervous Centres of Man, by means of their application to the Skin. By M. F. Bonnefin. (' Journal of Physiology, edited by Dr. Brown S£quard. No. 3.')
10. On Local Anaesthesia and Electricity. By Benjamin W. Richardson, M.D., &c. (' Medical Times and Gazette, September 11, 1858.')
11. On the Treatment of Paralysis by Electricity. By J. Althaus, M.D. ('Medical Times and Gazette, December 26, 1857.')
12. On Localized Galvanism, applied to the Treatment of Paralysis and Muscular Contractions. By Richard Moore Lawrence, M.D.—London, 1858.
If, jealous for its reputation as a therapeutic agent, electricity could just now become articulate, its earnest cry would be, " Save me from my friends!" Rescued, but a few years ago, from comparative poverty, obscurity, and disgrace, by the praiseworthy efforts of Golding Bird, Duchenne, and Richter, it advanced under the guardianship of these and like-minded men until it found itself not only in good society, but enjoying a somewhat proud position in the apparatus medicus of England, Germany, and Frauce. But, so soon as it had attained this eminence, and attracted the regard of the general community, numbers of men, who, judging from their own works, were unable to observe correctly or think wisely, gathered round the popular novelty; with a grand nourish of brazen trumpets announced themselves its protectors, and issued proclamations, in the form of worthless books, that this mighty agent, under the guidance of their mightier selves, not only would, but had healed all and every one of the "thousand natural shocks that flesh is heir to." From such vain pretension nothing but disappointment and disgust could follow, and already the tide of popularity is turning. Electricity cannot do what these, its so-called " friends," have asserted that it can; and, despite its manifold powers for good, it is in danger of being again regarded as a quackery, and condemned to another period of obscurity and neglect.
In France there are treatises on Electricity "appliquee au traitement curatif des nevralgies, des rhumatismes, des paralysies, des tumeurs, &c., et en general des affections morbides, souvent reputees incurables ;"f and in Germany there are similar productions,- written, as, Richter says, in "halb-popularer eoht-franzosisch floskel-reicher Weise," while in our own country there are individuals who write works for the purpose of instructing the profession and the public in the theory and practice of electric therapeutics, but manifest a lamentable want of aequaint
* We much regret that an important work by Dr. Remak, entitied, 'Galrano Theraple der Nerven nnd Mnskelknnkheitcus (Berlin, 1353), has reached as too late to be noticed In the present article. Ed. t By M. Briand.
ance with some of the first principles of physical and physiological science. The unqualified laudation which this valuable agent receives at the hands of such writers is not likely to secure to it a permanent place in our materia medica.
Convinced of the great utility of a well-applied electricity in properly selected cases, it is with earnestness that we protest against its ruthless and quack-like advertisement as a panacea, and shall endeavour, in the following article, to point out its real physiological effects, its true therapeutic position, and the best modes for its application.
Within the last ten years two articles on the employment of electricity in medicine have made their appearance in this journal. In the first of them* the researches of Dr. Golding Bird, Mr. Donavan, and others, were brought under review; and in the secondf an account was given of the then recent labours of Duchenne, Meyer, Guitard, and Richter; we shall not, therefore, in the present article, revert further to those positions which we considered established in the year 1855, but shall confine our remarks to the history of electricity, and especially as a therapeutic agent, since that period.
Those effects of electricity which may be termed "physiologic," differ widely in their character; their variety being dependent upon two classes of conditions, one appertaining to the electricity, the other to the organism.
As to the conditions inherent in the electricity, we must notice the quantity, intensity, and mode of transmission of the currents, each of which influences the physiologic effect.
The quantity of electricity is dependent, theoretically, upon the number of polar chains that can be established at the same time in a particular voltaic arrangement; and is determined, practically, by the size of the positive plate, and the relatively larger size of the negative. Other conditions affect the quantity of electricity, but do so only to a trifling degree. Now, although variations in the quantity of electricity occasion corresponding variations in its physiologic effects, the latter are, for the most part, brought about indirectly; i.e., through the intervention of some other changes, either thermal or chemical, which come between the electric force and the vital or physiologic result. Thus, the amount of heat generated in a wire connecting the two poles of a battery is in direct proportion to the size of a positive plate, or to the quantity of electricity evolved; and therefore, when an apparatus of such kind as to yield a large quantity is employed, a very painful amount of caloric is produced, which not only modifies the physiologic effects, but complicates and renders diflicult the therapeutical application. Again, the amount of chemical decomposition w'hich is produced by a voltaic apparatus, is determined by the quantity of electricity, or the number of polar chains which can be established; and this amount is sometimes so great that tissues are acted upon chemically, and their proper vital functions held in abeyance. A very strong current, as Bernard has shown, may destroy the property of a nerve, by acting chemically upon its tissue, thus producing a condition which differs entirely from that of exhaustion by a direct continuous current; for under the latter circumstances the inverse current restores the property, whereas in the former it is impossible to restore it.
Thus, the employment of electricity in too large quantity determines two classes of result which modify the physiologic effects—on the one hand the phenomena of sensation are deranged by the caloric produced; and on the other, nervous properties, of any kind, may be destroyed by chemical decomposition of the tissue. There are circumstances, however, in which both the thermal and chemical effects of galvanism are needed, such as the employment of the cautery, the coagulation of blood in an aneurysmal sac, the attempted solution of calculi, or the extraction of metallic poisons from the body; and as under all these circumstances a large quantity of electricity is required, the choice of instruments for such operations will be determined by their fulfilling that condition of supply.
The degree of tension, or intensity of the electric current, is, however, more bflaenti.il than its quantity in determining physiological results; and it is to variations in this quality that we ordinarily apply the terms "strong" and "weak." There are several currents in common use for physiological experiment and therapeutical exhibition; and as this quality of tension or intensity is predicated of all of them, it is necessary that we should describe separately the conditions upon which its variations depend. But before doing so, inasmuch as some confusion has crept into the language of modern electricians, we will state as concisely as possible what these several currents are, what are their proper names, and in what way they have been erroneously designated.
Iu the wire which unites the two poles of a voltaic arrangement,—whether this consists of one pair of plates, or of one hundred pairs,—there is, when the wire is unbroken, a current of electricity, termed the "initial current." This passes in the direction from the copper or negative metal, through the wire, to the zinc or positive plate. If this wire is broken, and the two ends of it are grasped by the hands, the individual so doing, becomes in that part of his body which intervenes between those two ends, a part of the voltaic apparatus; and the initial current passes through him in the direction described. If this wire, in any part of its course, be broken, there is at the moment of division, and existing at that moment only, another current setting in the opposite direction to that taken by the initial current. This has received various names: Duehenne has termed it an " induced current of the first order," but its proper designation is the "extra-current.''s'
Another wire placed near and parallel to the conducting wire,—viz., that through which the initial current passes,—has its polar condition so affected that via" induced current" is propagated through it in an opposite direction to the initial current. Several of such wires may be employed, at different degrees of proximity to the conducting wire, and in all of them there is an induced current, that which is nearest to the conducting wire being called the "induced current of the first order," the next of "the second order," and so on.
The currents employed by M. Duehenne, and about the different properties of which so much has been said and written, are the "extra-current" in the conducting wire, and an "induced current of the first order," in a parallel wire; and M. Becquerel states, that for Duehenne to designate them induced currents of the first and second order respectively:—" e'est creer . . . . un langage tout a fait different de celui qui est employe par tous les physiciens" (p. 89).
The most striking differences between these various currents are to be referred to their degree of intensity, and this is determined by different conditions, of which the following are the most important. The "initial current" is intense in proportion to the number of the active cells in the battery, the nature of the electrolytes employed, and the integrity of conducting material throughout the whole circuit. The force of the "extra-current" is determined by the same circumstances; but that of the "induced currents" depends partly upon these, and also upon other conditions—viz, the size of the wire, the length of it which is brought into proximity with the conducting wire, and the presence and degree of additional magneto-electric induction. Cceteris paribus, the finer the wire and the greater its length the more intense is the induction.
In order to obtain great, and at the same time convenient, length of the wires, they are twisted into the form of a hollow spiral, or helix, the latter becoming, in itself, endowed with magnetic properties, one end of the helix being a north and the other a south pole. If into the hollow of this spiral or helix there are introduced bars of soft iron or steel, these bars become magnetic by induction; and thus the electrical force, developed in the battery cells by chemical action, becomes resolved into the correlated force of magnetism. But precisely the reverse s order of induction may take place in another apparatus, and the "lifter" of a permanent magnet around which a copper wire is twisted spirally, at the instant that it becomes a magnet by induction, from contact with the poles of the permanent magnet, developes chemico-polarity, or electricity in the copper wire. The former