As to the mode of administration in this affection, I can suggest nothing. There is so little uniformity in the manifestations of hysteria, that it were idle to even attempt to establish anything like a routine electro-balneological treatment. Each case must make its own laws.

CASE VIII.* Mrs. A., aet. 28, married, sterile, from the clientele of Dr. KREMER, was referred to me on June 12th, 1874. She had been a sufferer from hysteria for a number of years. Among the more prominent symptoms were intense pruritus, transient flushing and heat of the entire surface, with pricking sensations and headache. Six baths, in each of which both currents were employed, sufficed to effect a complete and permanent cure.

CASE IX.* Mrs. E., from the clientele of Dr. KREHBIEL, aet. 28, married, of an exceedingly nervous temperament, had suffered from excessive nervous irritability and prostration since her last confinement (about a year previous to my seeing her). There was no organic trouble, the symptoms pointing to pure functional hysteria. She was sent for electro-balneological treatment April 21st, 1874. Six baths, in which both currents were employed, restored her to perfect health.

NEURASTHENIA.

(NERVOUS EXHAUSTION.)

Those who are familiar with the pre-eminent qualities as a neurotic of electricity, will not be surprised to be told of the beneficial effects in the condition under consideration of electric baths. It is not only in general nervous exhaustion, however, that electric baths exercise this salutary influence, but in the condition known as cerebral exhaustion likewise. Judging from my own experience, their efficacy in this latter condition is far greater than that of local applications, whilst they are unattended with any of the irritant and other disagreeable effects that even with the greatest care and caution we cannot always disassociate from galvanization of the brain. They no doubt act here in two ways, i.e., first and chiefly, through reflex influence from the entire periphery; second, by derived currents on the brain directly. Whatever their mode of action, the results obtained are of the most gratifying kind. The pitiable condition in which some patients of this class present themselves, is familiar enough to every physician; but it appears that the greater the degree of exhaustion and the more prostrate the various functions, the more striking are the effects of the baths. The patients seem to live up anew under their influence. While in many if not most other complaints that come under electro-balneological treatment, a certain number of baths are requisite in order to get discernible effects, in the disease under consideration each bath, except perhaps the first, is followed by more or less immediate improvement, which, if the treatment is persevered in, remains permanent.

It is almost unnecessary to say, that in the more advanced cases great care is requisite in the administration of the baths. By over-stimulation at first, much harm may be done, and the patient, instead of getting better, get worse. In such cases very mild currents should be employed in the beginning. As recuperation advances, stronger currents may be gradually introduced. The intensity of the currents should be carefully regulated to keep pace with the gradually increasing capacity of the various organs to respond to the electric stimulus without detriment. Both currents may be used from the first. The galvanic current should precede the faradic, and be employed for not more than ten minutes. Where irritability is a feature of the case, the current should be descending; otherwise ascending. This may be followed by the faradic current, not of sufficient intensity for the first few baths, however, to cause any but slight muscular contractions. In most of these cases iron may be advantageously added to the bath. The duration of the baths should at first not exceed fifteen minutes; in some cases this even is too long, the patient complaining of being fatigued perhaps after the lapse of ten minutes. When this is the case, the bath should be at once terminated. It is in these instances not the electric current, but the warm water bath, that gives rise to the sense of fatigue. Later on in the treatment, the duration of the baths may be from twenty to twenty five minutes, according to indications.

CASE X. Cerebral Exhaustion.—K. S., aet. 42, lawyer. First consulted me on June 2d, 1874. The salient points in the history of this most interesting case are as follows: Ten years prior to his calling on me he was engaged in some very heavy law cases and other duties requiring intense mental application. At that time he began to manifest occasional symptoms of cerebral exhaustion; was unable to endure mental exertion with same force as theretofore. These attacks, commencing in 1864, supervened at various times until 1868, sometimes incapacitating him for business for a few days at a time, and accompanied by intestinal catarrh, flatulence and gastric disturbances—probably the results of loss of nerve-power. In 1868, having been subject for a time to extra heavy mental strain, he was completely prostrated, and compelled to retire from the pursuit of his profession. By the advice of his physician he went to the country. There, without any premonitory symptom whatsoever, he suffered an attack of (left) hemiplegia. I quote from his recital as follows: "While standing in the office of the hotel registering my name in the book, I suddenly dropped down, retaining full consciousness. I lost the power of speech for some hours. After twenty-four hours the paralysis began to recede, and in a few days I had made a spontaneous recovery. I then went further into the interior. Two weeks subsequently I had a similar, but milder attack; retained full consciousness and mental control. Returned to city (New York) two weeks after this, in a very debilitated condition. On the third day after my return, I had a more violent attack than either of the preceding—again on the left side. I felt as if a line were drawn perpendicularly through my body, dividing it in halves. My stools were clay-colored. With this attack for the first time I became unconscious, and passed into a delirious state. So far as I know, no diagnosis of my condition was made. I was confined to bed for a month, at the end of which I was in a very feeble state. I then went to Europe, where I spent some years. While there I consulted the first physicians of London and Paris, with but little benefit, however. Both mind and body remained feeble. My normal weight is upwards of 120 pounds, but has for a long time past been in the neighborhood of 90 pounds."

When Mr. S. came to consult me, he had but lately returned from Europe, whence, he stated, his physicians had sent him home to die. His complexion was sallow, sickly; skin of face plentifully wrinkled; features wearing the air of suffering and anxiety that so frequently accompanies painful chronic conditions. He had for some time past suffered from excessive cerebro-spinal irritability, for the relief of which cantharidal collodion had been employed in the cervico-spinal region (the same had also been used in the hepatic region, to meet the diagnostic views of some one of his medical attendants). He had a remittent chronic intestinal catarrh, with—noticeably during the periods of exacerbation—abundant discharge of a glairy mucus. The appetite was very capricious—not to say poor, and he was obliged to be exceedingly careful in his diet. He was not capable of any continued mental application. The muscular system was weak and flabby. All the vegetative functions were more or less impaired.

On June 3d, 1874, Mr. S., by my directions, took an electric bath. He continued the baths daily for some weeks; then every two or three days, all the time steadily improving. He had some adjuvant medicinal treatment, probably similar to what he had already had in Europe. He states, however, that his improvement commenced with the first bath he took; and the baths certainly constituted the main treatment throughout. He gained daily in every respect. Mind and body were invigorated; his muscles increased in size and hardness; color gradually returned to his cheeks, etc. He continued the baths with more or less regularity until the close of the year, taking in all sixty-one baths. He was then in a better condition than he had been for many years. Thinking a trip to Europe would benefit him, I advised him to go there and remain a few months. He left early in January and returned in the beginning of April, 1875. He had been very well during his absence, until within a few weeks prior to his departure from Europe, when he experienced a severe attack of cerebro-spinal congestion, which caused him much suffering. On his return he resumed the baths, and continued them throughout the spring, continually gaining in strength and weight. At the beginning of last summer he was practically well. He has regained his normal weight (120 pounds). As a criterion of his bodily vigor, I will simply state that I have seen him lift, with ease, 350 pounds, which, for a person of his weight, is not bad. His mental force is as good as it has ever been. The digestive disturbances have disappeared; he can eat things which for years he had been compelled to eschew. To use his own words: "I am well." In view of the fact that he had already received, at the hands of competent men, all sorts of internal as well as external treatment, I believe I am justified in attributing his cure almost entirely if not solely to the baths.

CASE XI. Mr. * * *, aet. about 50, lawyer, of large, vigorous frame, came to consult me January 4th, 1875. He complained of symptoms that are the frequent results of prolonged mental over-taxation. His intellect was as good as ever, but he lacked his wonted mental endurance and power of application. His mind was perfectly clear, but unable to work. It was a case of "limited cerebral exhaustion." Physical nutrition was pretty good; yet his color was not normal, being rather paler than it had been and has since become again. His flesh was flabby. There were vague neurotic disturbances, etc., etc. He had until recently occupied a leading public position, and the onerous duties that devolved on him in connection with this, evidently stood in direct etiological relation to his trouble. I ordered an electric bath every other day. This was complied with until the end of February, when the patient had apparently entirely recovered his health, mentally as well as physically. I saw him not very long ago; he looked the picture of health, and told me that he was and had been since I saw him, perfectly well in every respect.

CASE XII. Mr. L., aet. 23, presented himself for treatment in October, 1874. He had at various times made the attempt to study some profession, but had never been able to concentrate his mind sufficiently on any object to enable him to persevere in its pursuit. He was fretful, irritable and vacillating; would desire one thing to-day, another to-morrow; never long of the same mind. Melancholia, digestive disturbances and hypochondriacal phenomena accompanied this condition. No organic disease was discoverable. On October 1st he took his first bath. Very shortly after this he commenced the study of medicine. He improved rapidly in every respect. During the month of October he had six baths, which resulted in complete and permanent relief of all the symptoms. He progressed satisfactorily in his studies, and is at the present time taking his second course in one of our city medical colleges.

AGRYPNIA.

(INSOMNIA; SLEEPLESSNESS).

Although, as a rule, but the symptom of some definite pathological condition, agrypnia is of such frequent occurrence, and so detrimental to the general health, that it appears to me to merit special consideration. This holds good especially in this connection, because, even where electric baths fail to influence the disease giving rise to the insomnia, they almost invariably remove this, irrespective of its cause. Even where, the disease itself remaining uncured, the insomnia must return sooner or later, the sleep is very much improved while the baths are being had recourse to. We must of course endeavor in all cases to relieve the original disease, and, where the baths are not adapted to this purpose, resort to other and appropriate means. It will be found of no small service to us in the therapeutical management of every case, to be enabled to procure for the patient, without the aid of medicinal hypnotics, sufficient of sleep during treatment.

CASE XIII. Mr. A., from the clientele of Dr. LEONARD WEBER, was sent by Dr. W. to take electric baths. He suffered from chronic spinal congestion. Among the most prominent and annoying symptoms was agrypnia. It was for the relief of this symptom chiefly that Dr. W. ordered him the baths. He began to improve in this respect from the time he took his first bath, and although the disease itself remained uncured, he enjoyed good sound sleep while he was under treatment, his general health improved, and he frequently spoke of the notable benefits that he received from the baths. He continued them until his departure for Europe, where, by direction of his physician, he went last spring. I have not seen him since, but Dr. W. tells me that he is doing well.

CASE XIV. Mr. D. was brought on Sept. 30th, 1874, by his physician, Dr. HOGAN. He was in the incipient stage of delirium tremens. Had not slept for some nights. Dr. H. had administered successively opiates, chloral and bromides in full doses, without effect. On the evening of above date the patient had a bath, in which the descending galvanic current was used. As a result, he slept well that night. The baths were repeated on the two succeeding days, with like effect. As the disease developed however it became necessary to send the patient to an asylum, whence he returned cured in a short time. The effect of the baths in this case, where full doses of the most powerful hypnotics of the materia medica had failed, was remarkably illustrative of their hypnotic power.

ANAEMIA.

As is well known to the profession, anaemia forms the basis of a great number of morbid conditions. Hysteria, general debility, emaciation, sterility, various nervous affections, phthisis, in short, a perversion of almost any of the various physiological functions may be the direct result of anaemia. On the other hand, anaemia may be only a symptom or sequel of some other morbid condition—but of such cases I do not now speak. I have to do here only with those cases where anaemia is the primary and etiological of a group of symptoms, and where therefore it is to this that the treatment must be mainly directed. Now let us see what this treatment is. Dr. FLINT[15] suggests the following therapeutic measures: "first, a nutritious alimentation, into which meat should enter largely; second, the use of tonics and stimulants to render the digestive functions more active; third, iron as a special remedy—the effect of which is often remarkable; and, fourth, a regimen calculated to increase the energy of the assimilative functions, consisting of exercise in the open air, recreation, etc." This agrees mainly with the views of other writers. It may conveniently be condensed under two heads, instead of four, namely: first, to secure for the patient appropriate food and adopt the best means to insure its assimilation; second, the administration of iron. As to the ingestion of appropriate food, open air exercise, etc., patients are of course to receive the necessary directions. The remainder of the therapeutic indications, as given above, are admirably met by electric baths. As we have seen in a preceding chapter (p. 43 et seq.), they are a tonic and stimulant of the first order, and as nearly as possible a specific for the furtherance of the digestive and assimilative processes. When impregnated with iron, they constitute a treatment for anaemia which, in conjunction with the requisite diet and other hygienic measures, is inferior to no other. It will moreover be found very efficacious in counteracting secondary anaemia, and thus, by maintaining the general strength of the patient, often enable nature and appropriate treatment to cope successfully with the original disease.

CASE XV. Mrs. S., aet. 22, four years married. I was called to see her on October 2d, 1874. She then had a spontaneous miscarriage, the fifth since her marriage. She asked me whether nothing could be done to enable her to carry a child to full term, as both she and her husband were very desirous to have offspring. In pursuance of my directions, she presented herself at my office about ten days after I first saw her. On examination I found no organic trouble, no uterine displacement, nor any other local trouble to account for her premature confinements. Involution had progressed normally. The only deviation from the normal that I could discover about the uterus was undue paleness of the cervical portion. Her appearance was very decidedly anaemic; features pale, flabby; lips whitish blue; physical energy much depressed. She had had but very slight loss of blood on the occasion of her recent miscarriage; certainly not enough to account for her anaemic appearance. Viewing her case as one of idiopathic anaemia, I ordered her electric baths strongly impregnated with iron. In addition to this, the regimen usual in such cases, and also strychnia and phosphorus internally. She took her first bath on Oct. 14th; then one bath weekly until she had taken six baths, the last of which was administered on the 24th of November. During all this time she kept steadily improving. The anaemic appearance and symptoms gradually receded, and, soon after she had taken her last bath, I discharged her, as far as the anaemia was concerned—cured. While she was under treatment she had, by my advice, refrained entirely from sexual intercourse. Early in the spring of 1875 she called to tell that she was again pregnant, and in November, 1875, I delivered her of a healthy male child, at full term.

PARALYSES AND PARESES.

I include these under one head, because not only is their origin frequently identical, but, chiefly, because the therapeutic indications are almost always the same in both. Whatever the cause in any given case, whether cerebral, spinal or peripheral, organic or functional; whatever the treatment that may be indicated—and this should never be neglected—for the primary trouble, the direct electrical treatment of the paralysis, sub-paralysis or paresis, being purely symptomatic treatment, remains in the great majority of cases essentially the same. The objects to be aimed at are two, viz: first, a normal state of nutrition of the affected muscles; second, their normal contractility. In other words, we are to endeavor to prevent atrophy of the affected muscles, or, where this has already taken place to some extent, to restore their normal bulk; and, second, we must strive to restore the more or less impaired contractility of the paralytic or paretic muscles. Even where symptomatic treatment for these purposes is the only treatment employed in a case, we frequently meet to a great extent the indicatio morbi, by favorably influencing, either in a reflex or direct manner, the primary disease. This is true of local electrizations of the affected parts; it holds good much more strongly however of electric baths, because here, in addition to the reflex influence that we get from local applications, we have also the direct influence of the electric current on the spinal cord and posterior portion of the brain not only, but on the sympathetic system and all the important organs contained in the thoracic and abdominal cavities. The great importance of this is apparent, when we reflect that in very many if not most cases of disease of the nervous system, central or peripheral, electricity in an appropriate form is a useful therapeutic agent, and that moreover the great majority of functional paralytic disorders respond favorably to its influence. As for any harm being done by it in those rare cases where its use may be contra-indicated, I admit that such may accrue from the administration of electric baths without medical supervision; it is entirely obviated however where the baths are under the supervision of a physician, who does not, like a layman, indiscriminately admit to their use any and everybody who is willing to pay for their administration, but will carefully discriminate, and conscientiously exclude those cases in which general electrization might result injuriously. In such cases a tolerably accurate diagnosis is as a rule readily made, and will enable the physician to separate the suitable from the unsuitable cases.

As to the mode of administration of the baths in cases of the class under consideration, the use of both currents is requisite; the galvanic as a nutrient, the faradic as an excito-motor agent. Where, as is sometimes the case, faradic irritability is extinct, or so slight as to be practically unavailable, the (slowly) interrupted galvanic current must take the place of the faradic, until faradic irritability has become re-established. As to the intensity, direction, etc., of the currents, each individual case has its own laws, which must be recognized by the supervising physician.

CASE XVI.—Infantile paralysis. Albert Pichl, aet. 22 months, was sent me by Dr. LILIENTHAL, October 3d, 1874. Had complete paralysis of right leg (of four weeks standing), with considerable atrophy of the entire leg as well as the gluteal region of the corresponding side. The temperature of the leg was much lower than that of the healthy limb. Faradic irritability was entirely extinct. The treatment was begun by galvanizations of the lower (lumbar and sacral) portion of the spinal cord, and the use of the interrupted galvanic current on the affected muscles. This was at first done daily. The contractility of the muscles gradually but slowly improved, but neither the atrophy nor temperature of the limb appeared visibly affected by the treatment. With a view to favorably influencing these conditions, I ordered him galvanic baths. He had a bath every alternate day. The result was favorable and rapid. The leg became sensibly and permanently warmer after each bath, and commenced steadily to increase in bulk. Faradic irritability soon returned. The local applications were continued several times a week for some time, and then gradually abandoned, the baths being meantime continued regularly. The boy very soon began to walk, and in December active treatment was discontinued. At that time, faradic irritability having long since become completely re-established, I caused the child's father to purchase a faradic battery to use at home. The limb was eventually entirely restored in every respect, with the exception of a slight abduction of the foot, for which I referred the patient to Dr. GIBNEY. I saw the child recently; he remains well.

CASE XVII.* Sub-hemiplegia from cerebral hemorrhage. Mrs. S., aet. 30, married, from the practice of Dr. KREHBIEL, was sent by Dr. K. to take baths, July 3d, 1874. It was a routine case, differing in no respect from what is ordinarily witnessed as a sequence of cerebral hemorrhage. Six baths, taken at intervals of two and three days, restored almost entirely the muscular power of the affected side. The patient subsequently made a complete recovery without further treatment.

CASE XVIII. Paralysis from insolation. Mr. P., proof-reader aet. about 40, had suffered for some time from sub-paraplegia, the result of insolation. He was sent to take baths in May, 1874, by his physician, Dr. SCHIRMER. Electro-balneological treatment in this case met with no success.

CASE XIX. Lead paralysis. Mr. M., aet. about 35, painter, was referred to me for treatment May 15th, 1874, by Dr. MOHN. The extensors of one (I believe it was the right) arm were paralyzed. The characteristic blue line about the gums was clearly defined. I ordered an electric bath daily. The descending galvanic current was used for twenty minutes each bath. From half to one ounce of iodide of potassium was added to each bath. The blue line became less distinct from day to day, until, after eleven baths, it had entirely disappeared. The object for which I had ordered the baths having now been accomplished, I treated the affected muscles with the faradic current. A short course of this treatment sufficed to remove the paralysis from all but one finger (it was either the middle or ring finger), the extensors of which had probably undergone fatty degeneration.

NEURALGIAE.

The great variety of causes that may give rise to neuralgia, precludes the possibility of any specific for this symptom. In discussing its electro-balneological treatment, I would observe a primo that I cannot, in the light of my personal experience, agree with those who claim for electrical treatment good results in a majority of cases.[16] On the other hand it cannot be denied that, either as a palliative or curative measure, electricity, employed in an appropriate form and manner, is of inestimable value in many cases, and frequently succeeds where all other remedies are of no avail. Where we know the cause of a neuralgia, it is of course comparatively easy for us to determine whether or not electricity promises to avail anything. But even where the nature of the cases appeared to indicate its use, the failures, in my hands at least, have outnumbered the successes. The brilliant results—sometimes almost instantaneous—that we obtain now and then, should not lead us into overlooking our failures. Undoubtedly the circumstance that most of the cases that have come under my observation were of a very obstinate nature, referred to me by other physicians after varied unsuccessful treatment, has much to do with the formation of my views as expressed above, and future experience may perhaps lead me to modify them.

Speaking still from my own experience, I will state that the cases that have proven the most amenable to treatment were, first, those of rheumatic origin; second, hysterical neuralgiae, and, third, cases where no assignable cause could be elicited. The most obstinate varieties were those of a malarial type (even when quinine in large doses or arsenic were employed in conjunction with galvanism) and those that depended on some form of chronic inflammation—neuritis, periostitis, etc. Of central neuralgiae, I have had excellent results in the sympathetic variety and in the pains of posterior spinal sclerosis, while in the neuralgiae of cerebral origin (diffuse cerebral sclerosis, tumors, etc.) I have never met with any appreciable success.

Where, then, we are able accurately to diagnose a case, there cannot be much doubt as to the appropriateness or not of electrical treatment, and in cases whose origin is obscure, which may be considered practically functional and therefore treated more or less empirically, electricity holds out as much or more hope than any other remedy. Whether electricity should be employed locally or in the form of baths, must depend on the features presented by each individual case. In neuralgia of the fifth pair—excepting those reflex cases where the point d'origine is to be sought for somewhere in the trunk or extremities, and those that depend on cerebral hyperaemia or anaemia, where the equalizing effects of the baths on the circulation are frequently of great benefit—these are generally useless. Of other neuralgiae, I have found the baths less successful in those of the superior than in those of the inferior spinal nerves. Lumbo-abdominal neuralgia and sciatica have yielded much more readily than brachial or dorso-intercostal neuralgia, etc., etc.

The mode of administering the baths in neuralgiae does not possess enough of uniformity to render suggestion in this respect of any value. I will state however that, as a rule, the best results have been obtained from the descending galvanic current.

In chronic cases the baths should be administered daily, and should not be discarded as unavailing until at least a dozen have been successively taken.

CASE XX. Sciatica. Mr. R., a middle aged man, mechanic, was sent by Dr. ARCULARIUS Nov. 9th, 1874. Had post-rheumatic sciatica of some six weeks' standing. There were no remarkable features about the case, which however was sufficiently severe to disable him from pursuing his avocation. He took his first bath on the date above-mentioned. Another bath was administered next day, and three more every alternate day. He was then almost well. On Nov. 25th he returned, there remaining still some traces of the affection. Four more baths, the last of which was administered on Dec. 4th, sufficed to complete the cure.

CASE XXI. Sciatica. Mr. G., aet. about 35, saddler, was sent by Dr. WAECHTER, March 6th, 1875. Had suffered from sciatica without discoverable cause for several years. For one year prior to his visit had been unable to work, and was confined to bed a great portion of the time. There was slight atrophy of the affected limb. He had had considerable medical (including local electrical) treatment, without avail. The baths were faithfully and persistently tried in this case, effecting however but slight improvement. Subsequent hypodermic injections, first of strychnia, then of atropia and finally of chloroform, the latter in doses ranging from 30 to 60 minims, gave him only temporary relief. The patient was finally discharged uncured.

CASE XXII. Lumbo-abdominal neuralgia. Mr. W., aet. about 40, was brought by Dr. MARVIN S. BUTTLES in June, 1875. He had been in poor health for a number of years, and was then in a very cachectic condition. There was considerable gluteal atrophy on the affected side. At Dr. B.'s suggestion he took a course of electric baths, with the happiest result. He improved steadily, and on the occasion of a late inquiry after I had not seen him for some months, Dr. B. told me that the patient had entirely recovered. His general condition as well as the neuralgia had been very favorably modified by the baths, and he is now in far better health than he has been for many years.

CASE XXIII.—Lumbo-abdominal neuralgia. Mr. G., aet. 40, came to consult me in October, 1875. He had suffered from neuralgic pains, more particularly in the renal region of both sides, but also in the neighboring parts, for only one week. The case being so recent, I entertained a very favorable prognosis, which subsequently was amply verified. A bath on the 12th of October and one on the 16th sufficed to effect a complete cure.

ARTICULAR EFFUSIONS.

It would appear at a first glance as though local galvanization of affected joints should be more directly and powerfully instrumental than electric baths in promoting the absorption of morbid deposits. To suppose so would however be a mistake—even where a single joint is concerned. Where many joints are involved, the advantages over local galvanization of the baths is sufficiently obvious. Where but a single joint is involved, the current can by means of the surface board be concentrated on the affected joint, while by the general galvanization a stimulus is furnished to the absorbents, that in itself is probably fully as important as any local treatment could be. In this manner absorption is made to progress much more certainly and rapidly, and this course is therefore to be given the preference in all cases where no special contra-indication exists.

The ascending general galvanic current should be employed for from 5 to 10 minutes. The surface board, connected with the negative pole, should then be applied for a few minutes successively to each of the affected joints. Iodine in some form should be added to the baths.

CASE XXIV.* Specific synovitis of knee-joint, with considerable articular and peri-articular effusion. Mr. C., from the practice of Dr. SHEPPARD, aet. about 35. First saw patient at his house on Nov. 9th, 1873, in consultation with Dr. S. and Dr. HUTCHINSON, of Providence, R. I. Had been on mercury and iodide of potassium for a long time. When I first saw him, he had been incapacitated from work for about a year. Had been unable to leave the house for three months. The affected joint was very much enlarged, with little or no mobility, the condition being practically the same as true ankylosis. It was decided to substitute tonics for the specific treatment, and to administer galvanic baths. On Nov. 11th the first bath was administered, another on the 15th, and a third on the 19th. Considerable improvement in motility was then apparent. Two more baths, taken respectively on the 22d and 29th, effected some reduction in the size of the knee. The baths were continued to January 3d, 1874, when the effusion had become almost entirely absorbed, and the joint perfectly mobile. The patient then had been for some time taking daily walks, unassisted. He now (Jany. 3d) walks without any difficulty, has regained his normal vigor, and is perfectly well.

IMPOTENCY.

The frequent obstinacy of this distressing condition under every variety of non-electrical treatment, is the cause of the frequency with which cases present themselves to the specialist. Unfortunately however but few of the referred cases are of recent origin. In almost all instances they have gone through a vast amount of medication and other treatment, and finally, either through their attending physicians or of their own accord, they come as a dernier ressort to seek relief from electrical treatment. I have already (p. 47) spoken of the comparative merits in this disease of local and general electrization. A few years ago I was ignorant of the good effects of the baths in male impotency. I came to test and employ them here from two causes. In the first place, patients were sent me specially for electro-balneological treatment, ordered by their physicians; and, second, I began, when I became familiarized with the effects of the baths, to have recourse to them in cases where with local electrical and other treatment I had been unable to accomplish anything. My average results, without becoming uniformly successful, became so very much better, that after a brief but abundant experience with this treatment, I have come to consider it the most important we possess in this affection; one that will frequently succeed when everything else, including local electrization, has failed, and which, in cases where no incurable organic changes underlie the affection, will, if properly persisted in, either cure or improve to a great extent a large majority of the cases. I have even seen instances where, the sexual power having receded as the legitimate result of advancing age, it returned almost or quite perfectly and with seeming permanency under the influence of the baths. In the class of cases—and they are quite numerous—in which impotency (loss of the power of erection) occurs as a purely nervous symptom in comparatively young men; where its cause is sometimes purely imaginative, at others the result of early excesses, the baths are attended with the most gratifying average results. Where the cause is purely psychical, a very few baths are sometimes sufficient to dispel the morbid phenomena. Where masturbation or excessive venery are at the bottom of the trouble, there is always a probability of more or less organic change in the lower portion of the spinal cord, and frequently also a secondary enfeeblement of the digestive functions, which render requisite a long and steadily continued use of the baths. Patients whose sexual power was intact, who took the baths for other purposes, have time and again called my attention to their aphrodisiac effects.

While here the general electric influence is the main remedial agency, there is no reason why the possible—or, I should say, probable—good to be obtained from its local influence should not be realized—the less so that it is so facile to obtain this in the bath, by means of the surface board. While individual cases will undoubtedly call for modifications, I have found the following plan to answer best in certainly more than half the cases that have come under my observation: The first five minutes of the bath may be occupied by a general galvanic current of medium intensity, descending where the patient is of an irritable, ascending where of a phlegmatic temperament. The pole connected with the foot electrode should now be detached, and the surface board substituted. The second five or ten minutes may be consumed by running a galvanic current between the head electrode and the surface board, the latter applied alternately to the penis, scrotum, perineum and, where thought best, also to the lumbo-sacral region. Where, as is usual, the impotency is accompanied by a certain degree of cutaneous anaesthesia of the penis, but especially where the seminal secretion is scanty, the board should be positive (ascending current); where however nocturnal spermatorrhoea, premature discharges (before coition is possible) or other irritable phenomena characterize a case, the surface board should be negative (descending current). The head of the patient should rest on a sponge thoroughly saturated with water, and communicating with the water of the bath, so as to include the cerebellum in the direct circuit. The last five or ten minutes of the bath should be devoted to passing the faradic current between the head electrode and the surface board, this last applied about the genitals, but chiefly about the perineum, the current to be of sufficient intensity to contract the perineal muscles. With anaemic patients iron should be added to the baths. These should be taken at first daily, later on every other day, then three times a week, and so on until it becomes apparent that all the good that can be obtained from them has been obtained—whether this be a perfect cure or only a certain degree of improvement. Where it is thought requisite, internal medication and various hygienic measures may be advantageously resorted to as adjuvants. While these will do no good when employed alone, they may serve to enhance the effects of the baths.

In the following cases, I will include some where the impotency was not perfect, where the conditions were merely those of sexual debility. As there is here merely a difference in degree, it would be superfluous to separate the two conditions under distinct heads.

CASE XXV.* Perfect impotency.—Mr. F., from the practice of Dr. CARO, a robust gentleman, aet. thirty-six, full of muscular vigor. Had had syphilis, the symptoms of which had disappeared under Dr. C.'s treatment. For two years the power of erection as well as sexual appetite had become extinct—if we except an occasional imperfect spontaneous erection on waking up in the morning, and even this was of rare occurrence. Ordinary medication proving inadequate, Dr. C. sent patient to take electric baths. From March 7th to July 16th, Mr. F. used the baths, averaging about two weekly. He was then, and still remains, perfectly restored.

CASE XXVI. Perfect impotency. A. E. K., aet. 23, commercial traveler, applied to me for treatment in the spring of 1873. His general health was very good. He had masturbated but little. Had been in full possession of his sexual power until almost twenty-two years of age, when he found that, without assignable cause, he had lost the power of erection. His general condition being, as far as discoverable, perfect in every respect, I instituted a local electrical treatment. This was continued for some time without avail. Strychnia was then administered with no better result, and after some months' treatment I told him that I could do nothing for him. He remained without any treatment whatever until the spring of 1874, when I advised him to try electric baths. He took in all about half a dozen baths, which resulted in his complete and thus far permanent restoration.

CASE XXVII. Sexual debility. Mr. W., aet. 32, married, manufacturer, consulted me in February 1875. Had gradually for about a year past lost sexual power. Was able to perform the marital act at rare intervals only, and when he did, felt exhausted the whole of the succeeding day. I ordered him electric baths. He took the first on February 22d, 1875. Between this date and March 22d, he took six baths. The sexual power had then fully returned. I must not omit to state that during the time he was under treatment he took, by my direction, gr. 1/25 phosphorus twice daily, which may have somewhat accelerated the result.

CONSTIPATION.

Atony of the muscularis of the intestine is admittedly the direct cause, in most instances, of constipation. It is the condition known as "torpor of the bowels." It is ordinarily due to abnormal innervation of the parts. The inefficient innervation may be—and in females frequently is—reflex, or its cause may be sought for in the central nervous system. The condition of the voluntary abdominal muscles is likewise a factor in the alvine process. Sluggishness of the abdominal (portal) circulation is a not infrequent etiological concomitant of constipation, and, finally, the conditions grouped as "dyspepsia" may form the causative feature of a case. I have mentioned these different causes simply in order to account to some extent for the almost wonderful effects in this condition of electric baths. When we consider that in every one of the morbid conditions here enumerated, electricity is a very efficient remedy, and that for the resulting muscular atony it may be called a specific, it will not appear surprising that a mode of application which brings the electric influence to bear on both cause and effect—often on a combination of several of the causes enumerated, should be attended with such brilliant results. I have thus far met with no failure in the electro-balneological treatment of constipation.

In the majority of cases the following method has proven the most efficient. The first ten minutes of the bath should be devoted to the administration of a galvanic current, as intense as can comfortably be borne by the patient. The one pole should be connected with the head-electrode, the other, by means of the surface board, applied alternately, to the epigastrium, chiefly, and to the hypogastric region. The current should a portion of the time be ascending, the rest descending. Occasionally the current should be rapidly reversed by means of the commutator, the intensity however having been previously reduced, in order to avoid too severe a shock; this will cause efficient contractions of the abdominal parietes, and probably also of the intestinal muscularis. The second ten minutes of the bath should be devoted to faradization, employed in the same manner as the previous galvanization, only that here the direction of the current is immaterial, and no reversals are requisite. The current should be of sufficient intensity to produce energetic but not painful contractions of the abdominal parietes.

CASE XXVIII. Mrs. * *, aet. 55, in average health, without however being robust, had suffered from constipation for about thirty years. She had had every possible medicinal treatment, with no avail. Nothing had ever ameliorated her condition. Without the aid of a cathartic, her bowels moved but once every week or ten days. She was of course compelled frequently to resort to laxatives. In the fall of 1873 I ordered her electric baths. She was not very energetic in anything, and this lack of energy caused her to take the baths less frequently than I desired her to. Had she taken them regularly, she would probably have been restored in as many weeks as it took months to effect her restoration. As it was, she took some thirty baths in the course of about fifteen months. For nearly a year past she has had a passage every day with the utmost regularity. No adjuvant treatment was employed in this case.

CASE XXIX.* Emil Miller, a bright child two years of age, was brought for treatment July 7th, 1874. He had suffered from obstinate constipation almost from his birth. Had been under the care of several physicians, but had never received any benefit from treatment. Even with the aid of powerful cathartics, given in doses suitable for an adult rather than a child, defecation took place only once every three or four days, and was so exceedingly painful as to elicit cries of pain from the child. The feces were always hard and lumpy, and of an abnormally light color. A digital examination per rectum revealed considerable flaccidity. My diagnosis was paresis of the muscularis of the intestine. I ordered faradic baths. On July 12th the first bath was administered, and I must confess that the result was a perfect surprise to me. True, I had expected a cure to take place; but I had looked for gradual improvement, and was not prepared for a result such as was here obtained. From the time the first bath was taken, defecation took place regularly once a day, without pain; the feces became perfectly normal both as to color and consistency, and the boy continues to the present day to defecate regularly and in every respect normally. To insure permanency, the baths were continued, at first twice, then once a week. They have now been discontinued for upwards of a year, there being no occasion for their further use. No other therapeutic measures, internal or external, were resorted to in this case, nor was any change made in the diet of the child.

HYDRARGYROSIS.

The etiology of this condition requires no comment. I will simply relate a case illustrative of the eliminative effects of galvanic baths.

CASE XXX.* Mercurial Stomatitis. Mr. S., about 35 years of age, came to me for treatment in the fall of 1872. He then had indurated chancre, two buboes and syphilitic sore throat. He had had the chancre for six weeks before applying to me, but had been, he said, ashamed to consult a physician. Before medication had had time to make any impression on the disease, roseola appeared. The syphilis was very obstinate in this patient, compelling me to keep him under the influence of mercury for a long time. In October 1873, the patient presented himself with a very aggravated mercurial stomatitis. The customary remedies, internal as well as external, made little or no impression on the affection. On November 11th, I discontinued all other treatment, and ordered a course of galvanic baths. He took his first bath on the same day. This was repeated every alternate day until six baths had been taken, when all symptoms of the disease had disappeared. He has had no mercurial trouble since then. The descending galvanic current from a zinc-carbon battery was used throughout.

LOCOMOTOR ATAXIA.

Were it not for the remarkable results obtained in the following case, I should not have felt justified in devoting any space to an allusion to this formidable disease. I insert the case as it was published in No. 216 of the "Medical Record." I have to add that the patient, some six months ago, suffered a relapse, which however is not nearly as aggravated as his former condition, nor are the symptoms so pathognomonic. I had a letter from him about a week previous to my writing this, in which he states that he intends soon to come to the city for the purpose of taking another course of treatment. Even if the treatment however has not had the effect of curing the disease—and this I do not claim for it, it has been of sufficient importance if it has resulted in arresting for a time its progress, giving the patient temporary comfort, and prolonging life. Further trial may possibly have better results—in more recent cases—with respect to permanency.

CASE XXXI.* Mr. W., aet. 48, came to consult me January 12th, 1874. He had then felt the symptoms of locomotor ataxia for about six years. Had been unable for several years to walk without the aid of a cane. When walking he dragged his right leg along in a semicircle, and was able to accomplish very short distances only. There were almost complete anaesthesia and great paresis of the bladder. The same conditions were observable in regard to the bowels. Anaesthesia of both lower extremities existed, complete in every respect in the right leg, almost so in the left. Dyspepsia and general debility and emaciation accompanied the disease. Treatment was begun on January 15th. I prescribed phosphorus and cod-liver oil, and passed a strong galvanic current through the spine for probably ten minutes. January 16th, a galvanic bath was administered. Towards the close of the bath (which occupied twenty minutes), patient thought he felt some sensation in his legs. The baths were taken every two or three days, alternating with strong galvanizations of the spine. While taking his second bath, patient remarked that "his right leg felt warm for the first time in six years." The treatment as described was continued for about six weeks, during the latter part of which the local applications were gradually diminished in frequency, the baths being continued regularly. Medication was discontinued about this time. About the middle of March. Mr. W. was enabled to resume his occupation (paymaster's assistant on the Erie Railway). His improvement had been rapid and steady. All the symptoms gradually disappeared, and in the beginning of April the patient was, with the exception of some feebleness, consequent on his protracted illness, as well as ever. He continues so to the present day.[17] He still takes two or three baths a month, but has had no other treatment since May (1874). He walks freely without a cane, and talks jocosely of running footraces. All functions are performed normally.

Although in this case the baths were not employed exclusively, yet they predominated in the treatment; and if the judgment of the patient, a very intelligent gentleman, is to be relied on, a large share of the success is due to the baths.

CACHEXIAE.

After what has been said in a preceding chapter of the tonic effects of electric baths, it would scarcely appear necessary to introduce the subject of cachexiae. If I do so nevertheless, it is only to be afforded the opportunity of relating the following case, which possesses sufficient interest to render its introduction here desirable. The first portion of it has already been published (Med. Record, No 216), but to this I have to add what occurred subsequently.

CASE XXXII.* Mercurio-syphilitic Cachexia.—Mr. L., aet. 27, had primary syphilis about four years ago. Subsequently had inveterate constitutional symptoms, for which he was under medical treatment both here and in Europe. When he had sojourned in the latter country some time, he was pronounced cured by his physicians. He married, and returned to this country in the fall of 1872. A few weeks after his return he fell into a gradual decline, which confined him to the house—and part of the time to bed—for eight months, during the latter portion of which he had discontinued all medical treatment. It was with difficulty that, assisted by his wife, he managed to reach my office. I found him terribly enfeebled; greatly emaciated; sallow complexion. He was much annoyed by rheumatic pains, which I considered specific. His condition was so exceedingly low, that I decided to postpone all medication until he should be stronger. I ordered galvano-faradic baths, i.e. the galvanic current in the bath as an eliminative, the faradic as a tonic. The first bath was taken on November 20th, 1873. For one month he took the baths, and nothing else. He was then so much stronger, that I felt justified in instituting a mild specific course of treatment, the baths being continued as theretofore. At the end of two months the patient was nearly as strong as ever, was able to resume his occupation, and had gained twenty-seven pounds in weight.

Thus far this case was published as above stated. For the sake of the interest attaching to it, I will now proceed to give its further history. Mr. L. remained to all appearances well until July, 1874, when he commenced to suffer from headache and constipation. On the 23d of August following, while I was absent from the city, he presented himself to the gentleman who attended to my practice during my absence, with paralysis of the external rectus muscle of the left eye. He also consulted a specialist, who pronounced the paralysis rheumatic. When I returned from the country he presented himself for treatment. I commenced a series of daily electric applications to the affected muscle, which failed to respond to the faradic current, but contracted very readily when the slowly interrupted galvanic current was employed. As I had strong suspicions that syphilis was at the bottom of the trouble, I also administered iodide of potassium in gradually increasing doses—not however until electrization and strychnia employed for some weeks had failed to do any good. The administration of the iodide met with no better success. The patient's general health gradually declined. On October 22d, he complained of numbness in the left leg, which gradually increased, the leg at the same time becoming paretic, so that the patient required the aid of a cane for ordinary locomotion. His condition now became rapidly worse. His movements became ataxic. Anaesthesia of the bladder, paresis of this and the intestine, with obstinate constipation, loss of appetite, emaciation, etc., rapidly supervened. I suspected the development of gummata on the meninges of the brain and cord, and advised him to use the inunction cure, and to remain at home until he should be well. This, on account of the business losses which it involved, he was very much averse to doing. He consequently proposed a consultation with an eminent physician, which was had. This gentleman pronounced the case one of spinal (either multiple or posterior) sclerosis, and discarded the syphilitic theory. A consultation two days subsequently with another physician had a like result. In deference to the opinion of these gentlemen, I treated the patient in accordance with their diagnosis. This was in the second week of November. The patient became rapidly worse. He soon ceased to walk—he tumbled about. After six days' treatment, considering his life in imminent danger, I reiterated my advice to institute the inunction cure, and the patient then acquiesced. Nov. 24th I ordered a drachm of Unguent Hydrarg. to be used every evening; I could not however prevail on the patient to remain at home during the treatment. He continued to grow worse. Nov. 26th he had complete retention from vesical paralysis, and sent for me at night to relieve him. Thenceforth until he got nearly well he was obliged to use the catheter regularly. A few days after this, fortunately for himself, he fell down as he was leaving a horse car, and sprained his ankle. I say fortunately, for this accident compelled him to remain at home. From this time he began to improve. December 2d I substituted for the ointment a twenty per cent solution of the oleate of mercury, of which he used a drachm morning and evening. The improvement from this day was exceedingly rapid. On the 4th of December he had regained control of the bladder. The constipation, which had been very obstinate, also began to yield. From this date he used the oleate only once daily, and discontinued it entirely on the 14th. On the 10th he had already resumed his avocation, and the same month absolutely danced at a ball. He took iodide of potassium for a time after his mercurial course. He has since been and is now in perfect health.

DYSPEPSIA.

The remedies for this disease are unfortunately so numerous, there is so much temptation to try another where one remedy has failed, that it is seldom or never that an uncomplicated case of dyspepsia applies for electrical treatment. As a rule, the disease that furnishes cause for referring a case to the specialist, is some nervous trouble secondary to the dyspepsia.

In regard to the influence of electric baths on dyspeptic conditions, whether complicated or not, I can however speak unqualifiedly in their favor. I know of no one other remedy that can at all approach them in this respect. Whatever the secondary or other troubles of patients, any co-existing dyspepsia was in every instance either cured or greatly ameliorated. The improvement usually begins at once—after the first or second bath, and continues steadily. As I have not had occasion to treat by means of electric baths any uncomplicated cases of dyspepsia, I can adduce none. I may safely claim however for the baths a reliability and bespeak for them a confidence that I might claim or bespeak for no other remedy or plan of treatment whatsoever—assertions which would appear rash and venturesome, had I not at my command abundant clinical evidence to warrant my making them.

MELANCHOLIA.

A case of melancholia, highly illustrative of the effects in this condition of electric baths, came under my notice very recently. It may serve as a guide in the treatment of this and kindred conditions.

CASE XXXIII. Mr. F., aet. 22, single, butcher, consulted me Oct. 21st, 1875, for melancholia and loss of memory, from which he had suffered for upwards of a year. He had frequently entertained the idea of suicide. A thorough examination revealed no trouble of any of the viscera. All functions appeared normal. He had never masturbated. There were no collateral symptoms to furnish any evidence of organic cerebral trouble. I prescribed phosphorus and strychnia, and galvanized the brain twice a week. Two weeks of this treatment had completely negative results. I then ordered electric baths. Four baths resulted in a complete cure.

INEQUALITIES OF THE CIRCULATION.

As a very fruitful source of morbid conditions of almost every nature, abnormities of the circulation of the blood are well worthy our attention. As is the case with dyspepsia, so here likewise patients seldom present themselves for treatment unless some definite secondary pathological condition has supervened. We find these patients complaining of cold hands and feet, irregular and disturbed sleep, occasional local congestions, with vague, usually slight pains here and there, etc., etc. Where organic cardiac disease is at the bottom of the trouble, we cannot of course expect much permanent improvement. Although even here considerable relief is often afforded while the baths are being used, their discontinuance will in all probability be soon followed by a return of the former condition. Where, however, cases are not complicated by organic disease, where we have a "sluggishness" of the circulation, due either to vasomotor inertia or atony of the muscular coats of vessels, the electric bath will be found reliably efficient. I have already (p. 55) alluded to this subject, and explained the probable "mode of action" here of the baths. I will now offer some suggestions as to the best method of administering them with a view to equalizing the circulation.

We must here seek to stimulate the vasomotor system, both central and peripheral; to give tone to the coats of vessels, both by direct and indirect electric influence; through counter-irritation to relieve internal congestions, by causing an afflux of blood to the skin. These objects are best attained by means of the galvanic current, which should be employed of sufficient intensity to produce a rubefacient effect. The faradic current acts in the same direction, but far less energetically, if we except the vessels near the surface, the muscular coats of which are probably more efficiently tonicised by this than by the constant current. The faradic current however is applicable here in another way, and for a very important object. I refer to the mechanical counter-action of a sluggish circulation, through the agency of prolonged muscular contraction. This mechanical effect is not of course peculiar to the faradic current; it is shared by gymnastic and other exercises; but obtained in any other way whatsoever (with the exception, perhaps, of massage, which is however much more troublesome as well as inferior, and moreover not always admissible) it involves, in order to produce perfect results, a considerable amount of bodily exertion, often beyond the physical power of persons who are in ill health, and bringing with it the risk of positive injury, through over-exertion, which with the passive contractions obtained by means of the faradic current, is entirely obviated. By administering the general faradic current in the bath, of sufficient intensity to maintain muscular contraction as long as the circuit remains closed, any stagnant blood in the lower extremities will be efficiently forced into the general circulation. After from three to five minutes of this faradization, the surface board may be successively applied for a minute or two each to the arms, abdomen, pectoral and dorsal muscles. I believe the best results can be obtained by first going through the faradic process, then subjecting the patient to general galvanization, as above indicated, and concluding by another but brief faradization.

AFFECTIONS OF THE SYMPATHETIC.

Last, but not least, I have some remarks to offer on the treatment by the electric bath of certain affections of the sympathetic nerve. While I do not in any such cases accord to the baths the rank of an exclusive remedy or even a specific, their importance as an adjuvant is sufficient to entitle them to special consideration in this connection. In those neuroses of the sympathetic where electricity (galvanism) is indicated, the greatest benefit can be obtained from local applications. On the other hand the baths, employed in addition to local applications, will be found a very important factor in the treatment, possessing, as they do, two advantages, viz: first, by their means, the electric influence is brought to bear—in a much less concentrated form it is true—on the entire sympathetic system, from the ganglion impar to the ganglion cervicale supremum, and, by derived currents, on the cephalic ganglia also, at one and the same time; second, the rest of the body participates in the general nutrient and tonic effects of the bath equally with the sympathetic, the latter thus receiving a reflex benefit which local applications fail to furnish. There are, moreover, cases where hyperaesthetic conditions of the nerve do not admit of local applications, and where yet electricity is urgently called for. Thus I have at present under treatment a lad sixteen years of age, in whom both supreme cervical sympathetic ganglia as well as the ganglion impar were until recently so susceptible that the mere adjustment of the electrodes caused him great pain, while on the other hand he bore the baths exceedingly well. In such cases, electric baths, suitably administered, frequently constitute in conjunction with proper medication, the most useful treatment.

As to the mode of administration in sympathetic neuroses of the baths, the most direct manner in which to influence the diseased nerve, is by connecting one pole of a galvanic battery (I consider the faradic current next to useless here) to the head electrode, the other to the surface board, the latter applied portion of the time to the epigastrium (solar plexus), the balance to the coccyx (ganglion impar). This will include in the direct circuit the main portion of the sympathetic, the position in the tub of the bather bringing the cilio-spinal centre very close to the head-electrode. The direction of the current must be determined by the individual features presented by each case, as also the duration of the bath.

CASE XXXIV. Mr. S., aet. 31, merchant, was referred to me April 3d 1874, by Dr. KREHBIEL. In January, 1874, Mr. S., until then in the enjoyment of good health, woke up one morning to find, as he expressed it, "everything dark before his eyes." He groped his way to the window, in order to open the blinds. When at the window, he felt as though about to fall out—probably vertigo. He soon returned to an apparently normal condition, and went about his business as usual. A week after, he had a much more serious attack, which he describes as follows: "I had been playing whist during the evening (several hours), when suddenly, without premonition, I felt as though a champagne cork popped against the top of my head, inside. Accompanying this was an indefinable sensation about the heart as though the blood all rushed thence down to the feet. I did not lose consciousness; did not fall. I trembled all over, and a great fear came over me. Felt very weak all night; my pulse was very slow." About two months subsequently, patient was referred to me, as above stated. He then had an uneasy look; an indefinable continual sense of fear; was excessively nervous in the forepart of the day; had brief attacks of tremor—usually every alternate morning, but not typical as to time of occurrence. The history exhibited neither syphilis, malaria nor intemperance. Had never had headache. Sleep good; appetite likewise. The most pathognomonic symptom, however, related to his pulse. This was abnormally slow, ranging from 44 to 54 (the latter only when standing or after walking) per minute. It was full and regular. There was no organic heart trouble. In the absence of any other symptom whatsoever pointing to irritation of the pneumogastric or spinal accessory, I was justified in excluding this as the possible cause of the cardiac infrequency. On the other hand, the pathogenetic manifestations appeared all to point to "asthenia of the sympathetic"—at any rate the portion of this whence the cardiac nerves take their origin, and I formed my diagnosis accordingly. In the beginning, the treatment consisted of bilateral ascending (from cilio-spinal centre to both mastoid fossae) galvanizations of the sympathetic, and galvanic baths (head electrode negative, surface board positive, to epigastrium) on alternate days. Improvement in every respect was steady, though not rapid. At the end of three weeks, I supplemented this treatment by the administration of ergotin and nux vomica. At the expiration of two more weeks, the patient being nearly recovered, I discontinued these medicaments, substituting the valerianates of zinc and iron, and steadily maintaining meanwhile the electrical treatment as above indicated. After a short time recovery appeared complete, and patient was discharged from treatment. He returned however a few months subsequently, complaining of "faint spells" in the mornings, accompanied with excessive nervousness, and a renewed though moderate cardiac infrequency. Electrical treatment, similar to that above described, soon restored him. One or two more slight relapses occurred during the next six months. For over a year past however Mr. S. has been in the enjoyment of perfect and undisturbed health. His normal pulse ranges from 72 to 80.

Whoever is familiar with the physiological effects of electric baths, will readily concede their great utility in a variety of conditions that I have not thus far specially alluded to. Of such I would mention ASTHENIAE, ATONIC AND DEBILITATED CONDITIONS GENERALLY, including the state of CONVALESCENCE FROM ACUTE DISEASES and the DECLINE OF ADVANCING AGE; many cases of CHRONIC HEADACHE; some INCLASSIFIABLE CONDITIONS OF MARASMUS and MALNUTRITION, etc., etc. In all such cases, when purely functional and uncomplicated by incurable organic disease, good results may be confidently looked for.

* * * * *

With these remarks I conclude my subject. Whichever the errors that a too limited experience may have engendered—and I doubt not there are many, I cannot on reviewing my work accuse myself of lack of candor nor yet of undue enthusiasm. I have cited but a small proportion of the successful cases whereof I possess records; still I believe that I have adduced amply sufficient clinical proof of the great value as a remedial agent of electric baths, and of the desirability of their more general adoption. I would more especially call attention to the inappropriateness of deferring their employment until almost all other remedies have been exhausted; and when I reflect that pretty much all those cases that had been referred to me by other physicians had already had the doubtful benefit of almost every other conceivable treatment, while many of those who came of their own accord, had in addition made the rounds of all the quacks, and exhausted nearly all the nostrums that are to be found advertised in the columns of our daily papers, the wonder seems that the results obtained were as good as they have been. I sincerely trust that in the future physicians will avail themselves more frequently than heretofore of a remedy that is certainly capable of accomplishing much good; and I hope that in addition to myself there will be found others, more competent, to devote themselves to the study of the subject. To these, and perhaps to myself at a future time, I relegate the task of correcting my errors and promulgating hitherto undiscovered truths.

Footnotes:

[Footnote 10: Centralblatt fuer die medicinischen Wissenschaften, No. 17, 1875.]

[Footnote 11: The apparatus used in these experiments was that of Du Bois-Reymond, with a Grove's element.]

[Footnote 12: Since writing the above, this case has had an entirely favorable termination.]

[Footnote 13: The cases distinguished by an asterisk were published in No. 216 of the "Medical Record."]

[Footnote 14: Wherever I use the word "general" as descriptive of an electric current used in the bath, it is not as a characteristic, but merely to distinguish it from the instances where the surface board is employed.]

[Footnote 15: Austin Flint, M.D. A Treatise on the Principles and Practice of Medicine. Philadelphia, 1873. 4th ed. pp. 63 and 64.]

[Footnote 16: See Beard and Rockwell, op. cit., 2d ed. p. 472.]

[Footnote 17: This was written a year ago. See remarks preceding the case.]



INDEX.

A. PAGE Agrypnia 92 Anaemia 93 Apparatus for baths 7 Articular effusions 105

B.

Bath-tub 8 Batteries 16

C.

Cachexiae 118 Chemicals in baths 15 Chorea 80 Circulation, effects on 55 " inequalities of 123 Clinical Record 61 Conductivity of water, etc. 13 Constipation 112 Counter-irritant effects 56

D.

Debility, general 129-130 Diagnostic uses 53 Digestive apparatus, effects on 44 Dyspepsia 121

E.

Electric Bath compared with other electrical methods 32 Electrodes 10

G.

General Therapeutics 52

H.

Hydrargyrosis 115 Hypnotic effects 38-58 Hysterical affections 82

I.

Impotency 106 Insomnia 92 Invigorant properties 57

L.

Locomotor Ataxia 116

M.

Melancholia 122 Mind, effects on 51 Miscellaneous disorders 129-130 Mode of administration 19 Muscular contractions 50

N.

Nervous Exhaustion 84 Neuralgiae 100 Neurasthenia 84 Nutrition, effects on 59

P.

Paralyses 96 Pareses 96 Physiological effects 31 Prophylactic influence 60 Pulse, effects on 41

R.

Rheumatism 67 " acute 68 " chronic 74 " subacute 73 " cases of 77

S.

Sedative effects 48-58 Sexual apparatus, effects on 46 Sexual debility 106 Sleep, effects on 38 Special therapeutics 61 Stimulant effects 43 Surface board 14 Sympathetic, affections of 126

T.

Temperature, effects on 41 Tonic properties 43-57



[Transcriber's Notes: The table below lists all corrections applied to the original text.

p. 029: [normalized] the sub-acute symptoms -> subacute p. 056: GENERAL COUNTER IRRITANT -> COUNTER-IRRITANT p. 056: [normalized] the use of the surface-board -> surface board p. 059: does ... became apparent -> become apparent p. 067: [normalized] acute, sub-acute and chronic -> subacute p. 073: [normalized] bi-carbonate of soda or potassa -> bicarbonate p. 107: ordered by their physicians: -> physicians; ]

THE END