be familiar with the chemistry of most diseases; when they shall know the exact organic poisons that produce them, with all their exact antidotes and eliminatories; when they shall look upon the cure of some maladies as simply a series of chemical problems and formula; when they shall melt down all calculi, necrosed bones, etc., chemically, and not remove them by surgical operations; when the bleeding in amputations and other wounds shall be stemmed, not by septic ligatures or stupid needles, but by the simple application of hæmostatic gases or washes; when the few wounds then required in surgery shall all be swiftly and immediately healed by the first intention; when medical men shall be able to stay the ravages of tubercle-blot out fever and inflammations -avert and melt down morbid growths-cure cancer-destroy all morbific organic germs and ferments-annul the deadly influences of malaria and contagions, and by these and various other means markedly lengthen out the average duration of human life; when our hygienic condition and laws shall have been changed by state legislation so as to forbid all communicable diseases from being communicated, and remove all causes of sickness that are removable; when the rapidly increasing length of human life shall begin to fulfill that ancient prophecy, 'the child shall die an hundred years old '-when there shall have been achieved, too, advances in other walks of life far beyond our present state of progress; when houses shall be built, and many other kinds of work performed, by machinery and not by hands alone; when the crops in these islands shall be increased ten fold, and abundance of human food be provided for our increased population by our fields being irrigated by that waste organic refuse of our towns, which we now recklessly run off into our rivers and seas; when man shall have invented means of calling down rain at will; when he shall have gained cheaper and better motive power than steam; when he shall travel from continent to continent by submarine railways, or by flying and ballooning through the air; and when-to venture on only one illustration moretiresome surgical addresses shall no longer be required to be written by longwinded so-called orators, nor listened to by the long-suffering, uncomplaining members of associations." (This last sentence is slightly paraphrased from the original).

These utterances unquestionably seemed altogether utopian at the time they were breathed forth by their gifted, far-seeing author; but from what has already been realized in the directions here indicated are we not justified and encouraged to look to the future with the keenest feelings of hope and confidence, as well as to the past with equally lively feelings of pride and gratitude; for who shall presume to say so far as the march of modern scientific medicine and surgery are concerned, "thus far shalt thou go and no farther."

For my own part, Mr. President, I have long felt that our profession, as such, has been entirely too modest. Like true worth in general it has refrained from asserting itself and demanding the power and position justly due it. The irresistible logic and force of facts and circumstances, however, are working many deeply important changes on men and things, and to the watchman on the watchtower nothing is more obviously perceptible among the coming events of the near future than the promotion and elevation of the medical profession to a position of eminence and power which its intrinsic greatness and vital usefulness justly entitle it to.

ON THE APPLICATION OF THE ELECTRIC CURRENT IN CERTAIN CLASSES OF DISEASES.*

BY JOHANN FLINTERMANN, M. D., DETROIT, MICHIGAN.

It is with some feeling of embarrassment that I come before you to-night with a weak attempt to make a few remarks on the application of the electrical current in the treatment of certain diseases. Looking through the daily newspapers of our land we hardly find one that does not contain an advertisement recommending the use of electricity for every disease. Very seldom do our medical journals contain articles scientifically treating of the use of electricity in medicine, although the advertising pages abound with recommendations of electrical batteries, instruments and appliances. The offices of medical men are more or less provided with batteries, the electric current is frequently applied, but reports of cases treated by electricity are seldom given. When I see the electric current applied, and the way in which it is done, I very often ask myself how is it that professional men, who are careful in administering medicine and who follow the strictest rules in cases of operation, become careless when they resort to electricity as a curative remedy. Is electricity in itself a thing that does not need careful study? Where is the man among you who would give to the people a pound of powdered opium and say that opium is a good remedy for stopping pain, leaving it to an unexperienced youngster to give it in any form and any strength? Certainly such carelessness would be criminal and negligent, and yet in electricity just such things are done every day. Without any knowledge of the nature of electricity or the laws which govern its different physical and chemical changes, without which no uniform results can be obtained, medical men resort to electricity. A man who wishes to apply electricity as a remedial agent must make himself familiar with several facts. It is necessary first, that he should have a good knowledge of the physics of electricity; he must understand what instruments are needed, the electrodes, the instruments. of precision, the different kinds of apparatus; he must know the laws of physiology, the anatomy of the parts where treatment is to be applied-topographical, systematic anatomy, the histology, the pathology of the processes for which the electric current is used as a remedial agent. Without a thorough knowledge of all these, and without a good knowledge of general medicine the application of electricity is a fraud.

The foremost and principal question is, At what strength must a current, or may a current, be applied, and what means do we have to measure the strength of the current? Two definitions must be familiar to the electro-therapeutist if he wants his actions to be governed by reasoning and calculation, namely, the density of the current and the meaning of the word resistance. Next in importance to these two definitions is the question, How long may an electric current be employed? The question of resistance has lost some of its importance by the absolute measurement of the strength of the current, but anyone familiar with the subject knows that in many instances the question of resistance must be taken into serious consideration. Density of the current is such a very important factor that without it an approximate measure of the strength of a current for *Read at a stated meeting of the DETROIT MEDICAL AND LIBRARY ASSOCIATION, and published exclusively in The Physician and Surgeon.

electro-therapeutic action is entirely impossible. The time has passed when an electro-therapeutist tried to emancipate himself from the uncertain task of ascertaining the intensity of the current by only mentioning the number of cells used or perhaps adding to his report the deflections of an unreliable galvanoscope. Nothing was said about the size of the electrode's resistance of the galvanoscope used in the case. But even to-day we will meet with reports of cases in which the absolute measure of the galvanometer is given without stating to what extent of body-surface the current was applied. What does a report amount to that gives only the number of milliampères without further defining its practical effect? If we state a certain strength for a certain electrical application and if we describe its application for a certain purpose on a certain area of the body, we mean to say by that that the accurately measured area on the surface of the body has been given to a certain quantity of current as a transverse surface in the circuit. Or, to speak more properly, the current must enter and leave certain parts of the body at a certain strength and at a well defined density. The curative effect of the electrical treatment is dependent upon the density of the current passing through the desired parts. According to this explanation to apply a weak or strong current means in the one case to bring these parts of the body under the influence of electrical currents which are more diffusely distributed in the other, under the influence of concentrated currents. If the transverse diameter of the part to be treated does not change, in such a case a weak current or a current of small density can only be produced by the decrease of the strength of the current; a strong current only by an increase. Letting D stand for density of current, I for strength of current, and T for the surface of the transverse section, we have the formula, D-I÷T. Or, in case the cross-sections remain constant the density of the current is directly proportional to the strength of the current. If density is the chief factor in the curative effect of the current, and if this leading principle has been formed from experience and experiments made touching upon this point, then it follows from the formula, D=I÷T, that if we desire the effect of a certain intensity of a current I' with a certain density D', we must take a cross-section T'. Or, in other words, we must apply a certain strength of current on an area of certain surface. This must be our first work when we apply the electrical current, to ascertain the density of the current to be applied by having the intensity of the current divided by the exact measure of the surface area.

In cases of sciatica I should recommend two differently shaped electrodes, one in the form of a rectangular parallelogram and the other of oval shape with a surface of seventy square centimeters and a current of an intensity of four milliampères. In spinal affections, treating by stations, by which I mean that I commence from upwards, and then select different stations below the point, at which I start, I always have the current flowing from the dorsal to the anterior surface of the trunk. In some cases I use large electrodes with surfaces of more than six hundred square centimeters, but keep the D of the current in the ratio of one to eighteen.

For circumscribed cases, as for instance, myelitis transversa, which we sometimes may be able to localize by a spot tender on pressure between the fifth and eighth vertebral bone (processus spinosi et transversi), or for chronic intercostal neuralgia over this area and in this region, one rectangular electrode in the back

and one of oval shape in the epigastric region is found serviceable, each electrode measuring fifty-five square centimeters. D=I÷T. D=one-eighteeth-three

fifty-fourths I=three milliampères.

In cases of the affection of the roots of lumbar nerves, where distinct puncta dolorosa posteriora are found, take a broad plate, covering the lumbar vertebral bones, of one hundred and five square centimeters and an oval plate of one hundred and ten square centimeters opposite on the abdomen. Then figuring approximately, since one is to eighteen as six to one hundred and eight, the intensity of the current ought to be six milliampères.

For an inflamed wrist I use concave electrodes measering thirty-five square centimeters and a current whose intensity is two milliampères. In these cases the current flows in a transversal direction through the locus morbi. But the law, which we have defined, holds just as well for cases where the current flows in a longitudinal direction, if the poles are some distance apart, and if for this reason the curves of the current are able to reach lower points, before they converge again towards the poles, as for instance, in the treatment of the spine in longitudinal direction. In such cases a weak current is used, either ascending or descending; one of the poles is placed on the lumbar vertebral bones and the other on the neck. (If the upper electrode is applied in the neighborhood of the occipital bone, a decrease of strength occurs in the current).

Every rule has its exceptions, and so has our rule of the density of the current. It can easily be proven that in spite of all facts favorable to the principle of weak currents, very often modifications become imperative on account of the impractical size of the transverse sections of the electrodes and the distance between them, not forgetting the locality of the body and the individual case of the disease. In order to illustrate the reason for exception to the rule, I want to mention a case in which we apply a current in a longitudinal direction, having the poles but a short distance apart, and where the curves of the current are only enabled to penetrate to a sufficient depth by great density, as for instance, in a case which we treat by applying the current in the direction from the jugulum to the ganglion sympathici supremum. Here we take two thick buttons, surface only ten square centimeters. Although the sympathicus reacts to the weakest currents, in this case where we use so exceptionally small-surfaced electrodes, the curves of the current are so very few, that only by the high excitability of this nerve can it become evident why the strength of the current is one-fourteenth instead of one-eighteenth. A similar increase in the density of the current takes place in spite of the opposite application of the electrodes. In cases of simple rheumatic affections of the joints, which have no other symptoms than pain by motion, tenderness at pressure, swelling, no color, rubor, but the parts covering the joints are cold, which very often has by reflex action the same effect on the whole extremity, either the arm or leg, D in such cases should be one-fourteenth, and in cases where there is little reaction, one-tenth. The same D must be applied in chronic traumatic affection of the joints. In cases of disease of the joints, where you apply the electric current, it is necessary that a very large area be penetrated by the curves of the electric current, a surface larger than is necessary, when you apply electricity for affection of the medulla spinalis or of a circumscribed affection of a nerve. Therefore a current of considerable D on the electrodes is needed in order to furnish a sufficient quantity

of the current to the diseased joints, in spite of the fact that the curves of the current distribute themselves on a larger area as soon as they have left the electrodes.

Torpid affections of the foot, knee, hand, and in all cases where adhesions are liable to be formed, in which it is your aim to have hyperæmia rather than anæmia, a current of D one-sixth should be applied, and even above this D. It is advisable in such cases to use the commutator. Certainly for diseases of the central organs our rules for density of the current are limited in the opposite direction. In brain treatment as a rule D=I÷T-one-twenty-fourth; in easily influenced individuals D=one-twenty-eighth-one-thirtieth. In cases where applications must be made in the neck, and sometimes in cases where the electrodes are applied in the superior dorsal regions in persons of cerebral anæmia, it is advisable to have D from one-eighteenth to one-twenty-fourth, as very often by the curves of stronger currents a dullness in the head is complained of, as if from pressure, dizziness and a feeling of fainting.

All acute cases with symptoms of high inflammation, all recent, all erethic cases, as for instance, myelitis, neuritis, neuralgia, etc., are best treated by applying the current with a density below the degree mentioned. Individual cases require scrutinizing inquiries and cautious trials as to the degree of density the patient will bear. Very often only half the average D (one-thirty-fifth) is sufficient, often you must apply even weaker currents. In certain functional disturbances with nervous irritation the application of electrical current with small D very often work like a charm. Hemicrania spastica, D-one-seventh, duration two to three minutes, using reophore plate of twenty-two square centimeters, current of about two milliampères; cathode on the angulus maxillæ inferioris, a second reophore plate of fifty-five square centimeters on the cervical vertebral bone as anode. In cases of paralytic form, in order to cause a contraction of the cerebral vessels and capillaries D on the ganglion supremum should be one-tenth, duration thirty to forty seconds. It is, however, always advisable to make the smaller electrode the anode, as it is less painful.

For what length of time a current should be applied during one session, depends on the nature of the affection and personal equation of the patient to be treated. How often such treatment should be repeated depends on the same factors. But one point I always insist on, namely, that the patient, if possible, should rest after each treatment, even if only for a short time.

There are many other points in connection with electrical treatment, which I have not touched upon in my short disclosure this evening. But for lack of time, and that I may not tax your patience long, I shall leave them for some future paper.

A FOREIGN BODY IN THE EAR.*

By WM. LOCKHART, M. D., DETROIT, MICHIGAN.

THE foreign bodies which find their way into the ear include a great variety of little things-things animate and inanimate.

Of the animate bodies which have been discovered in, and removed from, the *Read at a stated meeting of the DETROIT MEDICAL AND LIBRARY ASSOCIATION, and published exclusively in The Physician and Surgeon.