ON THE

DIFFERENTIAL INDICATIONS

FOB THE

USE OF THE FARADIC AND GALVANIC CURRENTS.

BY

A. D. ROCKWELL, M. D.,NEWYORK.

[REPRINTED PROM THE NEWYORK MEDICAL JOURNAL, PER, 1877.]

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ON THE

DIFFERENTIAL INDICATIONS

FOE THE

USE OF THE FARADIC AND GALVANIC CURRENTS.

BY

A. D. ROCKWELL, M. D.,NEWYORK.

IREPRINTED FROM THE NEW TORE MEDICAL JOURNAL, FEB., 1877. ]

NEWYORK:D. APPLETON & COMPANY,

549 & 551 BROADWAY.

1877.

ON THE DIFFERENTIAL INDICATIONS FORTHE USE OF THE FARADIC AND GAL-VANIC CURRENTS.1

The differential indications for the use of the faradic andgalvanic currents is one of the most interesting and impor-tant themes for consideration in the department of medicalelectricity; and I undertake its discussion the more readily,since the accumulated investigations and experiences of thepast decade have wrested many things that are important fromthe domain of speculation, and clearly established their bear-ings and relations. The relative value of the two currentsresolves itself mainly into a question of experience. Bothare valuable aids in the treatment of various diseases, bothare frequently serviceable in the treatment of the same dis-ease, while in certain conditions the faradic current is aloneindicated, and in others the galvanic. One, with a certainline of experience, finds that his best results have beenthrough the use of faradism; while another, with a differentclass of cases, finds that galvanism is best adapted to his use.

This idea finds its illustration in a number of articles thathave appeared during the past year or so, regarding the rela-

1 Eead before the New York Medical Journal Association, November, 1876.

4

tion of electricity to pain. The well-known power of thegalvanic current to relieve many forms of pain is repeatedlyemphasized, while the efficacy of the faradic current in thesame direction is seldom referred to; hence the inferencevery naturally is that the latter, for this purpose, is of butlittle value.

The truth is, that faradisrn is not only invaluable in manyforms of pain, as will be indicated further on, but in certainconditions relieves, where galvanism is not only useless, butworse than useless, since it serves only to exaggerate the ex-isting distress. The simple question of the value of one cur-rent, as compared to the other, is therefore worthy of but littleconsideration ; being simply two manifestations of one force,they have each their functions, both as independent and sup-plemental agents.

The differential indications for the use of faradisrn andgalvanism may, on the contrary, well demand the closestscrutiny, for on the accuracy with which we estimate theseindications will largely depend the success of our efforts. Ifwe do not clearly appreciate the difference in action, andadaptation to symptoms, of the currents, we either fail to ob-tain results that are obtainable, or valuable time is lost in thechange of treatment.

An intelligent and satisfactory estimate of this point de-mands both a knowledge of the physical and physiologicaldistinctions of the currents, and an experience that has notonly been sufficiently extensive and varied, but that has beencarefully and systematically formulated. In regard to thefirst (the physical and physiological distinctions of the cur-rents) it has been so repeatedly treated of from time to timein medical journals, and is so thoroughly discussed in specialtreatises which are readily obtainable, that I shall not enterupon their consideration in detail, but shall rather attemptsome practical observations drawn from personal experience.

The known physical and physiological distinctions of thetwo currents do indeed afford sufficient data to enable usat times to differentiate with accuracy in the selection of thecurrents, and the application of certain methods.

For example : the faradic current, by virtue probably of

5

its greater mechanical effects, is powerfully tonic in its action,and by the method of general faradization is indicated inmany cases of nervous exhaustion, and by localized faradi-zation in the mal-nutrition and atrophy of muscles.

The galvanic current, by virtue of its greater power ofovercoming resistance, is indicated when wr e wish to act uponthe central nervous system, and, through its superiority inexciting nerve-irritability, we use it to produce contractionsin paralyzed muscles that fail to respond to the faradic. Sofar forth, then, our knowledge of electro-physics and physi-ology can prove directly serviceable in the adaptation of theproper treatment, but none the less must we to a very con-siderable extent rely upon the aid afforded by repeatedclinical observation. In a practical review of the subject athand, it seems natural to consider—1. Those diseases, or symp-toms of disease, which seem to demand the faradic current;2. Those that call for the galvanic; and, 3. Those in whichboth are frequently and interchangeably indicated.

1. Concerning those diseases that seem to demand thefaradic current alone, there is but little to be said. Thereare in various generic diseases, if I may so speak, specificsymptoms that invariably demand one or the other of the twocurrents, and even special qualities of current—and to thispoint allusion will presently be made; but there are fewdistinct organic or functional conditions that in every phaseof their manifestation demand alone and always any specialform of electricity.

Asthenopia, a symptom depending on an absolute orrelative deficiency of energy in the muscles of accommodationor of the internal recti, and accompanied by hypereesthesia ofthe retina and of the ciliary nerves, is about the only distinctdisease that seems to demand the faradic current alone. Iwill not say that galvanism is never serviceable; but my ex-perience, at least, seems to teach that the instances wherefaradisra is not immeasurably superior to galvanism are soexceptional as practically to exclude the latter from consid-eration.

2. In regard to the exclusive use of galvanism, there isalso but little to be said, although it certainly has a somewhat

6

wider range. I would designate spinal irritation, certainsequelae of cerebro-spinal meningitis, and most of those skin-affections in which electricity has been shown to be of ser-vice, as the distinct diseases in which the galvanic is uni-formly superior to the faradic.

3. Those diseases in which either current may proveequally efficacious, or where at one stage of the symptoms thegalvanic, and later, the faradic current is indicated.

Paralysis may be said to be the disease for which elec-tricity is par excellence the remedy, and yet, as is well known,it is frequently of very little use where the symptoms arisefrom certain organic conditions, but may be absolutely contra-indicated. In hemiplegia, where there exists, as is so oftenthe case, an exalted electro-muscular contractility, electricity,if used at all, should be used in the form of faradization, andwith an exceedingly mild and rapidly interrupted current.

Under this treatment, improvement in the symptoms isnot unfrequently accelerated, the paralyzed member becom-ing stronger, and the muscular contractions less readily pro-duced ; and, even when muscular contractions are somewhatless readily called out than in the normal condition, the samecurrent is as a rule preferable.

But when, on the contrary, there is a very great dimi-nution, and even, relatively to the faradic current, a completeloss of electro-muscular contractility, the galvanic current isalways indicated, the faradic coming into play only when themuscles give evidence of considerable reaction to its influence.In paraplegia, whether depending upon an absolute struct-ural change in the cord, or upon causes that result in simpleanaemia or hyperaemia, we generally find, after a short time,complete or approximate loss of farado-muscular contractility.The galvanic current is alone applicable in these cases, for thespecific purpose of restoring nerve-excitability, although thefaradic is useful in attempts to improve the impaired nutritionof the paralyzed members.

The difference in the reaction of the two currents is typi-cally illustrated in facial paralysis, and especially when it re-sults from the action of cold (rheumatismal ) or compression.

In these cases the faradic current does not cause con-

7

tractions, while not only do the muscles respond to the gal-vanic, but a much weaker current will answer than when theparts are normal.

As the patient improves, it takes an increased tension ofgalvanism to cause the same effects, until finally farado-mus-cular contractility becomes manifest. This phenomenon hasbeen observed also in traumatic paralysis of the peronealnerve, and in a case of rheumatismal paralysis of the circum-flex nerve. The above as a clinical fact is thoroughly sub-stantiated, but it is interesting to note how it is reenforced byelectro-physiological experiment.

Erb, and after him Ziemssen and Weiss, found that, afterthe laceration or division of the sciatic nerve in a rabbit, theexcitability of the muscles through the first week becamediminished for both currents; but subsequently, while farado-muscular contractility became more and more feeble, galvano-muscular contractility rapidly increased, until two cells causedcontractions. The following is in brief the explanationoffered by Onimus for these differences in the action of thetwo currents : •

The duration of a current is the important factor in theproduction of muscular contractions. The closing of an in-duced or faradic current is only 0.0114" in duration,, whilethat of the galvanic is of a second, hence the faradicmorereadily excites the healthy nerves and muscles; but, whenthese are diseased, a longer action is necessary, hence the gal-vanic is most potent. It is claimed that the faradic currentdoes not directly cause contraction of a muscle, but indirectlythrough the intra-muscular nerves; the galvanic current, onthe other hand, has a feeble action on intra-muscular nerves,but exerts a powerful action on idio-muscular contraction.The probability that, in facial paralysis of rheumatismal origin(the cold acting on the periphery), the intra-muscular nervesare attacked from the beginning, accounts for the rapid lossof farado-muscular contractility, while the absence of profoundalteration of the muscular fibres, over which the galvanic cur-rent has such a ready action, accounts for the retention ofgalvano-muscular contractility.

In the essential paralysis of childhood, the farado-muscular

8

contractility is generally diminished, and often abolished,while occasionally the galvanic current, as in facial paralysisfrom cold, produces contractions more readily than in health.If the muscles respond in any marked degree to faradization,it should be used; if not, galvanism is indicated.

The relief of pain, whether of a psendo-neuralgic or hys-terical character, or whether dependent on true neuralgia orother causes, is a very important function of electrization;but in no condition has it been more difficult to discriminatecorrectly in the selection of the proper method of electricaltreatment. True neuralgia, as defined by Anstie, is withoutdoubt most successfully treated by galvanism, while hystericalneuralgia, and the so-called pseudo-neuralgia, which are sim-ply forms of pain, occupying certain areas, and running seem-ingly in the direction of certain nerves, yield most readily tofaradism.

More specifically, the effects of pressure in the variousforms of neuralgia are exceedingly useful, as guiding symp-toms, indicating the proper current. Ido not by any meanslay it down as a universal law, but it will certainly be foundthat, in the great majority of cases of neuralgia, where firmpressure over the affected nerves aggravates the pain, thegalvanic current is indicated, while the faradic current hasthe greater power to relieve when such pressure does notcause an increase of pain.

In the class of cases called sometimes hysterical hyper-sesthesia, it is well known that firm and prolonged pressureaffords marked relief, while pressure superficially appliedincreases the distress. The faradic current is here infinitelysuperior to the galvanic. In the treatment of the pain ofherpes zoster, galvanism is invaluable. In many cases thathave fallen under my observation, I have never known it tofail to afford either complete or approximate relief. Theeffects of galvanism on the extreme suffering that so oftenaccompanies mammary cancer are often little short of magi-cal. I have in many' instances seen the acutest agony relievedinstantly, and, while this relief is necessarily seldom if everpermanent, it is possible in many cases, by repeated appli-cations, to keep the pain in abeyance for months, and thus

9

the necessity of constantly administering opium is in a measureobviated. For the relief of neither of the last-named diseaseshave I found faradization to be of essential service.

As we advance to the consideration of those other formsof disease which experience has shown to be more or lessamenable to electrical treatment, it will be found to be moredifficult, without submitting the patient to preliminary andtentative applications, to discriminate between the currentsbest adapted to the case in hand, but I venture to assert thatin cases of chorea, of amenorrhoea associated with anasmiaand debility, and in cases of nervous exhaustion in general,we cannot often err if we resort to the faradic current by themethod of general faradization, either independently or as anadjunct to other treatment.

I once heard a very worthy preacher say that a life-longunbeliever, who happened casually to attend his ministrations,heard him allude briefly but earnestly to the central idea andfoundation principle of the faith to which he held and whichhe advocated. The man was persuaded, and ever after, on allsuitable occasions—be the theme of his discourse what itmight—the preacher never failed, either directly or incident-ally to refer to this central thought, in the hope of 'impress-ing its truth on others.

In like manner, I beg to be allowed to allude briefly tothis subject of general faradization as a constitutional tonic

?

not only because I believe it to be the central idea of electro-therapeutics, and to have a wider range of usefulness thanany other one method of application, but because withoutsuch allusion the treatment of my subject would be veryincomplete. It is now nearly ten years since the power ofelectricity as a tonic was first advanced, and supported bytheoretical considerations and clinical illustrations.

Because, perhaps, of its novelty alone, this theory excitedat first not a little attention both at home and abroad, butwT as subsequently quite neglected, so concerns any ade-quate allusion to it, by those who have prominently writtenand lectured. The evidences, however, of carefully elaboratedindividual experiences have greatly multiplied during the pastdecade, and furnished abundant proof of the correctness of

10

this theory, but unfortunately very few liave undertaken towrite upon the subject, and these individual experiences, sorich in results and so important as evidences, are practicallylost.

Electricity, more than any other therapeutic means, drawsto it the folly, ignorance, and cupidity of the land, but all ofsuccess that has been achieved by these charlatans has beenby some stereotyped application of this method, ignorantlydirected; of the evil that has followed the efforts of these“blind leaders of the blind,” no man knoweth. I would,therefore, most earnestly urge those wdio are especially in-terested in this department to carefully study the modus ope-randi—the rationale and effects of general faradization, withthe full assurance that a practical and patient application ofthe principles involved will not only amply reward all expen-diture of time and labor, but will be instrumental in at leastnarrowing the field where greed and ignorance prey upon thesuffering and credulity of mankind.

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