slowly, though the contraction as a whole may be larger than
that of a normal muscle. This excessive contraction is known
as hyperexcitability to galvanism. This form of contraction
is that obtained when the muscle fibre itself is stimulated.
Again, whereas in normal muscle KCC>ACC, when the nerve is
degenerated KCC = ACC or ACC>KCC. Also in the more severe
forms of nerve injury tetanic contractions may be set up in the
paralysed muscles, by closure of the current either at the anode
or kathode. These charges are known as the reaction of degeneration
or RD, and are of great value in diagnosis. They occur only
after sudden or acute damage to the nerve cells of the anterior
horn of the spinal cord, or to the motor nerve fibres proceeding
from these cells. Thus RD is present in infantile paralysis,
acute neuritis, &c., but absent in progressive muscular atrophy
where the wasting of nerve and muscle takes place extremely
slowly. The reaction of degeneration in the nerve is shown by
disappearance of reaction to either kind of current, preceded for
some days by hyperexcitability to either current. Where the
muscle wasting is due to a lesion in the muscle alone, as in
ischaemic myositis (usually due to injury from tight bandaging
or badly applied splints), no reaction of degeneration is found;
the only change is a loss of power in the contraction. If the
damage to the anterior horn cells be only very slight, there may
only be partial RD, and the prognosis is given according to the
extent of RD. From this account it is clear that the greatest
value of the continuous current lies in its use in diagnosis. But
it is also applied extremely successfully, in combination with
massage, to cases of infantile paralysis. Wrist drop from lead
poisoning and lead neuritis of all kinds, reflex muscular atrophy
and the muscular wasting of hemiplegia, are all benefited by the
continuous current; the severe pain of sciatica, and the inflammation
of the nerve sheath in these cases, can be arrested more
quickly by galvanic treatment than in any other way. Nearly
all forms of neuritis, both of the cranial and other nerves, are
best treated by the continuous current. The action in all cases
is to stimulate the natural tendency to repair, very largely by
improving the circulation through the injured parts.
Another effect of an electric current is electrolysis, and the phenomena of electrolytic conduction involve not merely the ionization of the compounds, but also the setting in motion of the ions towards their respective poles. Solutions which conduct electric currents are called electrolytes, and in the case of the human body the electrolyte is the whole mass of the saline constituents in solution throughout the body. When a current is passed through an electrolyte, dissociation into ions takes place, the ions which are freed round the anode being called anions and those which are freed round the kathode being called kations. The anions carry negative charges and are consequently attracted by the positive electricity of the anode. The kations carry positive charges, hence they are repelled by the anode and attracted by the kathode. But a certain number of molecules do not dissociate, and hence in an electrolytic solution there are neutral molecules, anions and kations. The chemical actions, and thus the antiseptic, remedial or toxic effects of electrolytes, are due to the actions of their ions. The phosphides and phosphates may be taken as examples. Some are extremely toxic, while others are quite harmless. But it is to the phosphorus ion that the toxic or therapeutic effect is due. In the phosphates the phosphorus is part of a complex ion possessing quite different properties to those of the phosphorus ion of the phosphides. The strikingly different effects of the sulphates and sulphides are due to similar conditions, as also of many other compounds. There are certain solvents, as alcohol, chloroform, glycerin and vaseline which do not dissociate electrolytes, and consequently the latter become inert when mixed with these solvents. These solutions do not conduct electricity, and hence ionic effects are extremely slow. A vaseline ointment containing 5% of phenol makes a good dressing for an ulcer of the leg, and produces no irritant effect, but a 5% aqueous solution may be both caustic and toxic. Since the toxic or therapeutic action of a solution is due to its ions, the action must be proportional to the number of ions in a given volume, that is, the action of an electrolyte depends on the degree of dissociation. Thus a strong acid is one that is much dissociated, a weak acid one that has undergone but little dissociation and so on. In 1896–1897 it was shown that the bactericidal action of salts varies with their degree of dissociation and therefore depends on the concentration of the active ions. In the medical application of these facts it must be remembered that when an ion is introduced into the body by electrolysis, it is probably forced into the actual cellular constituents of the body, whereas the drug administered by one of the usual methods though circulating in the blood may perhaps never gain access to the cell itself. Hence the different effects that have been recorded between a drug administered by the mouth or subcutaneously and the same administered by electrolysis. Thus a solution of cocaine injected subcutaneously produces quite different effects to that introduced by electrolysis. By the latter method it produces anaesthesia but does not diffuse, and the anaesthesia remains strictly limited to the surface covered by the electrode. It would appear that the ion is never introduced into the general circulation but into the cell plasma.
In the technical working of medical electrolysis the most minute precautions are required. The solution of the drug must be made with as pure water as possible, recently distilled. The spongy substance forming the electrode must be free from any trace of electrolytic substances. Hence all materials used must be washed in distilled water. Absorbent cotton answers all requirements and is easily procured. The area of introduction can be exactly circumscribed by cutting a hole in a sheet of adhesive plaster which is applied to the skin and on which the electrolytic electrodes are pressed. The great advantage of electrolytic methods is that it enables general treatment to be replaced by a strictly local treatment, and the cells can be saturated exactly to the degree and depth required. Strong antiseptics and materials that coagulate albumen cannot be introduced locally by ordinary methods, as the skin is impermeable to them, but by electrolysis they can be introduced to the exact depth required. The local effects of the ions depend on the dosage; thus a feeble dose of the ions of zinc stimulates the growth of hair, but a stronger dose produces the death of the tissue. Naturally the different ions produce different effects. Thus the ions of the alkalis and magnesium are caustic, those of the alkaline earthy metals produce actual mortification of the tissue and so on. According to the ion chosen the effect may be caustic in various degrees, antiseptic, coagulating, producing vascular or nervous changes, &c., &c. And again electrolysis can also be used for extracting from the body such ions as are injurious, as uric and oxalic acid from a patient suffering from gout.
One of the latest advances is the treatment of ankylosed joints by the electrolytic method, the electrolyte used being chloride of sodium, and the marvellous results being attributed to the introduction of the chlorine ions. This sclerolytic property of the current is applicable to all parts of the body accessible to the current. Old cases of rheumatic scleritis, entirely unaffected by the routine treatment of salicylates and iodide, have often cleared up entirely under electrolytic treatment. Cases of chronic iritis with adhesions and old pleural adhesions are also suited for this method of procedure. Certain menstrual troubles of women and also endometritis yield rapidly to electrolysis with a zinc anode. Before this method of introduction, the zinc salts, though excellent disinfectants, acted only on the surface in consequence of their coagulating action on the albuminoids, but by the electric current, under the influence of a difference of potential, the zinc iron will penetrate to any desired depth. Cases of rodent ulcer unaffected by all other methods of treatment have been cured by electric kataphoresis with zinc ions, and the method is now being applied to the treatment of inoperable malignant tumours. As very strong currents are required for this latter, the patient has first to be anaesthetized by a general anaesthetic. Another direction in which electric ions are being used is that of the induction of local anaesthesia before minor surgical operations. Cocaine is the drug used, the resulting anaesthesia is absolute, and the operation can be made almost bloodless by the admixture of suprarenal extract.
