THE DOCTOR'S BAG

ELECTROTHERAPY - the shocking treatment

By Keith Souter aka CLAY MORE

In my first western novel Raw Deal at Pasco Springs, believe it or not, one of the main characters is a doctor. He considered himself to be an up-to-date doctor and used electrotherapy in his practice. He was not alone in that, for doctors in Europe and America were adding it to their range of treatments. 

Here is a snippet:

Lucinda squeezed Tom’s hand while Doc Hawkins deftly sutured the wound on her shoulder.

‘You were lucky my girl,’ the doctor remarked, peering through wire framed spectacles perched on the tip of his nose. ‘A few inches East and …’

‘Don’t even think of that, Doc,’ Lucinda said with a shiver. ‘It’s bad enough that they murdered poor Curly.’

The doctor straightened up and sucked air between his teeth. ‘Your arm’s going to feel real numb for a few days, unless I stimulate the nerves and muscle.’ He  crossed his consulting room to a table on the far side of his roll-top desk. It was bedecked with strange looking glass jars full of liquids, rods and copper coils. He selected one with long wires leading from it and returned to the couch.

‘The very latest in medicine from back East,’ he explained. ‘This is a galvanic battery for giving what they call Faradic Stimulation.’ He handed Lucinda a rod to hold while he strapped a paddle gently over her upper arm.

‘This’ll tickle a bit,’ he informed her as he twisted wires together on top of the battery. Immediately the muscles on her arm started to twitch so that despite herself, Lucinda giggled.

‘Why it’s making my arm move all by itself,’ she uttered in amazement.

‘This is the future, folks,’ said the doctor. ‘Copper! These wires transmit electric currents. Back East they have buildings illuminated with electric light.’ His  eyes twinkled almost reverently, as if he could see this vision of the future. ‘One day we’ll laugh at our primitive kerosene lamps and simple electric batteries like these.’

Lucinda giggled again. ‘I think you’d better turn this tickling machine of yours off now Doc, or I’m going to pee myself with laughing.’

 Electricity was definitely in the air in the nineteenth century. That is to say that the discoveries about electricity that had been made in the previous century had opened up whole new areas of research. The Italian Luigi Galvani (1737-1798) an anatomist and professor of obstetrics at Bologna University had performed experiments on frogs’ legs and discovered that electricity could make them twitch. Then Alessandro Volta (1745-1827), a professor of physics at Pavia University invented the first battery, the voltaic pile.

It seemed that this was a power that could have immense benefit in medicine – and all sorts of folk started using it.

John Wesley and Ethereal Fire

The name of John Wesley (1703-1791) is forever associated with Methodism, which he founded along with his younger brother Charles Wesley. He was an Anglican minister but found himself banned from many pulpits because his religious views were considered radical. He therefore travelled extensively, both in England and America, preaching in open areas to the poor whom he often found to be excluded from churches. In America he railed against the practice of slavery.

            Not only did he believe that he was called to help people with their spiritual needs, but he also wrote about medicine and how people could use self-help techniques when they were ill. His book Primitive Physick was published in 1747 and was widely sold and used.

In that same year he saw for the first time an exhibition of Galvanism, or the use of electric batteries called Leyden jars to create shocks. Wesley was quick to grasp the opportunities that this amazing power, which he called ‘ethereal fire’, could hold. He became a devotee of electrotherapy and began using it to treat the poor on his travels and in a special free dispensary that he established. In 1759 he wrote The Desideratum, or Electricity made plain and useful.

Wesley subscribed to the theory that ethereal fire, as they knew electricity, caused capillaries to dilate and that it released all manner of blockages that were causing disease.

Soon ‘ethereal fire’ was being used to give shocks to people to cure them of arthritis and rheumatism, epilepsy, blindness, paralysis, back pain, sciatica and that cursed affliction of the spirits, melancholia or depression. So successful were his treatments that other dispensaries were established and Wesley’s reputation as a healer soared.

            Many of the conditions that he treated may have been amenable to electrical shocks. Certainly his use of it in depression may have been one of the only effective treatments at that time.

Nineteenth century electrotherapy

The Victorians were ingenious at constructing machines and gadgets. There was something awe-inspiring about medical machines with wires, rotating parts and cylinders and flasks that sparked and produced shocks. Doctors all over Europe and America invested in electrotherapy machines to treat everything from headaches to piles. Indeed a common treatment for piles was called ‘anal Faradism’, which involved the insertion of a rod into the rectum, followed by an electrical discharge to singe the piles. It must have been excruciating.

            All manner of belts, straps, rings and supports, which could be ‘charged’ were devised. They all had a dramatic effect, since they would produce a sensation that people could feel, and since they felt it so strongly it would be likely to produce a strong placebo effect. This is not to say, however, that any beneficial effect would be purely placebic, since we know today that various types of electrical stimulation can be helpful in the management of pain. Transcutaneous Electrical nerve Stimulation, or TNS is such a method commonly used today.

              And the belt had an internal attachment to help with other problems!

            Of less certain effect, however, would be the Galvanic Spectacles, which were invented and patented by Judah Moses of Hartford, USA in 1868. A British patent for a similar invention was granted to John Leighton in 1888. These consisted of a spectacles frame with a zinc plate and a chrome plate which settled over the bridge of the nose, with leads that attached to a small galvanic battery. A discharge of electricity was thought to stimulate the optic nerve, which they proposed would improve the eyesight. Some users of the galvanic spectacles even suggested that it would clear sinusitis and cure the common cold.

            In Paris in 1853 Dr Guillaume Duchenne published an account of his success with electricity in various conditions.  His work A Treatise on Localised Electrization and its Application to Pathology and Therapeutics was to prove influential in medical circles.

            Doctors working in the medical asylums of the day had virtually no effective treatments. Patients were physically restrained and there was no drug that could help psychotic states or the harrowing condition of depression. Electrotherapy seemed to offer some help, even if no-one knew how it worked. There were three types of electricity that they could use. Galvanism, which produced a direct current. Faradism or an induced current. And Static electricity given directly or charged in a Leyden jar. However, despite initial promise and continued use during the Victorian era the results were quite disappointing and eventually it fell into disuse. It was not reintroduced until 1938 when Cerletti and Bini introduced a very specific therapeutic use of electricity in the technique of Electro-Convulsive Therapy, or ECT, in which electricity was applied to one or both hemispheres of the brain in order to induce a convulsion.

            Other doctors were not to rigid and thought that electrotherapy had a legitimate place in the treatment of rheumatic and arthritic conditions. Indeed, it was in this area that its use would thrive all through the Victorian era and well into the twentieth century. Even today in the twenty-first century it has a place in many painful conditions, when used under the guidance of appropriately trained practitioners. 

Hell on the Prairie, the sixth Wolf Creek book features Keith (Clay More's) character Dr Logan Munro, the town doctor in THE OATH, a story about a spectre from his past. 

Logan has been in Books 1, 4 and 6, and 8 and is scheduled for more.

And his other new character, Doc Marcus Quigley, dentist, gambler and occasional bounty hunter continues in his quest to bring a murderer to justice, in RATTLER'S NEST in his  ebook short stories THE ADVENTURES OF DOCTOR MARCUS QUIGLEY published by High Noon Press.

Raw Deal at Pasco Springs, featuring that electrotherapy-toting doctor was originally published by Hale as a Black Horse Western, but is now available as an ebook from Western Fictioneers Library.

THE DOCTOR'S BAG

THE BLESSING OF ANAESTHESIA

By Keith Souter aka CLAY MORE 

Anaesthesia is one of the great blessings of modern medicine. Until an effective means of inducing unconsciousness was devised people had to depend on copious amounts of alcohol, a good strong piece of leather or wood (or a bullet) to bite on and the speed and skill of the surgeon or bonesetter.

The development of anaesthetics (and please put up with the British way of spelling) was not straightforward.  As with most things in the development of medicine it was a mix of chance, bravery and scientific endeavour.

Dr Thomas Beddoes and Pneumatic Medicine

Dr Thomas Beddoes (1760-1808) was a believer in many things in his time and in a way he was a catalyst for some of the spectacular advances that would occur in Victorian science and medicine. Indirectly, he as a place in the history of anaesthesia.

Some of his ideas were decidedly odd. One such was his observation that butchers rarely suffered from consumption (tuberculosis). When he asked some of them why they thought this was the case he received the reply that the inhalation of the odours in the slaughterhouse was heath-giving! He pondered on this and concluded that the air from the lungs of beasts may be the key and so he actually introduced windows into his clinics through which cattle could poke their heads and breathe upon the ill. Some patients, however, were not so happy about the smell of dung that they were also forced to endure.

When he settled in Bristol he set up the Pneumatic Institute for Inhalation Gas Therapy in nearby Clifton. He firmly believed that the various gases that chemists were discovering were just variants of air and that each gas had the potential of healing. Carbon dioxide, for example, had been used to treat consumption. Beddoes planned to extend the range and use hydrogen and other gases.

He decided that the institute needed a chemist to help him and as it happened, the young man that he appointed was the twenty year old Humphrey Davy. This was fortuitous for it gave Davy opportunity to develop his skills as a chemist. Soon Davy was inhaling gases that he produced in the laboratory. One of these was nitrous oxide, which he found was quite intoxicating. Not only that, but on one occasion he was suffering from toothache and he discovered that inhaling the gas actually gave pain relief. Strangely enough, although he was working in a purported medical institute no-one realised the potential that laughing gas would have. It fell to an American dentist to discover this fact forty odd years later.

Surgical humbug and dangerous inhalation

In 1824 Dr Henry Hill Hickman (1801-1830) a young Shropshire country doctor had followed Dr Beddoes’ ideas of inhaling gases and experimented on animals. He induced the state of what he called ‘suspended animation’ in these animals by making them inhale carbon dioxide gas. He then operated upon them in a seemingly painless manner. He advocated that it should be tried on humans, but his suggestion evoked ridicule. Indeed, an article in The Lancet totally derided his work under the title Surgical Humbug.

            Hickman did not leave it there, but took his ideas to France, where he obtained a hearing and actually read a paper to King Charles X. The paper was then forwarded to the Academie Royale de Medicine, but once again nothing came of it.

           

 In fact, carbon dioxide would induce such a state, but it would also induce panic attacks in humans. Worse, it could be fatal! The idea of using gas, however, albeit in this case the wrong one, did have merit as a means of inducing a sleep like state.

            

The big three

By 1831 three anaesthetic agents had been discovered. They were, chloroform, ether and nitrous oxide. In 1842 in the USA Dr Crawford W long (1815-1878) performed three minor operations on humans using ether. Two years later in 1844 a dentist, Dr Horace Wells (1815-1848) used ether on himself and had one of his own teeth removed.

A friend of his, Dr William T G Morton (1819-1868) used it to perform surgery in a demonstration to other doctors. It was the beginning of a new era for surgery and the name ‘anaesthesia’ was devised by Oliver Wendell Holmes.

Back in Britain in 1847, James Simpson started to use chloroform, which was less irritant and more pleasing to be given. He advocated giving it to mothers during labour, but met with opposition from the Calvinist Church, who said that it was natural for a woman to endure pain to bring a child into the world. This view was quickly scotched, however, when in 1853 Dr John Snow (1813-1858) gave chloroform to Queen Victoria herself when she had her son Leopold. He repeated this in 1857 when her majesty gave birth to her daughter Beatrice.

Giving anaesthetic

The casualties of warfare would have been extremely grateful for the benefits that chloroform brought them. But it was a fairly imprecise business and it was not without risk of death. Dosage was based on experience rather than scientific measurement. It was also unpleasant, since it indices a suffocation feeling ad patients were wont to panic. Accordingly, surgeons would be reassuring and sometimes would give brandy or laudanum first. Indeed, this was the regular practice in the Confederate Army during the Civil War. 

Chloroform is a liquid that was given by various methods. Children would be given it by the 'drinking glass method.' This involved putting a wad of cotton in a glass and soaking it with chloroform. The glass was then held over the nose or the mouth by the child or patient and as anaesthesia was induced, the glass fell away. 

Another method was to make a cloth cone and drop it onto this, placed over the nose and mouth. Then a sort of mesh was used as a face mask, rather like a small sword fencer's mask, on top of which a cloth was placed, upon which chloroform was dropped. 

                                                            Chloroform anaesthetic mask

There were two stages of chloroform anaesthesia. The first was a dulling of consciousness, often associated with hallucinatory images, wild-eyed excitement, then sometimes by panic if a suffocative feeling came on. Muscles could go into spasm, and if these included the laryngeal muscles then real suffocation could occur. The second stage resulted in unconsciousness when the muscles could go very floppy in some cases, again risking respiratory paralysis, which could be fatal. 

These were considerable problems with early anaesthesia and late on intubation of the larynx allowed anaesthesiologists to safely deliver oxygen and other gases directly to the lungs, thereby making it a lot safer to be anaesthetised. 

Chisolm's inhaler

During the Civil War the supplies of chloroform were often less than sufficient and there was a need to be more scientific in the application. 

The Confederate surgeon Julian John Chisolm invented a small inhaler consisting of a flattened cylinder, measuring 2.5 by 1 inch, with two tubes which could be inserted into the nostrils. The chloroform was dripped into a perforated disc onto a cloth. It apparently reduced the amount needed to about ten per cent of the amount previously used.

If you have been following the Wolf Creek series you may have seen Doctor Logan Munro using his Chisolm inhaler!

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Hell on the Prairie, the sixth Wolf Creek book features Keith (Clay More's) character Dr Logan Munro, the town doctor in THE OATH, a story about a spectre from his past. Logan has been in Books 1, 4 and 6, and is due to appear in books 8 & 9.

And his other new character, Doc Marcus Quigley, dentist, gambler and occasional bounty hunter continues in his quest to bring a murderer to justice, in THE SHOOTER the fifth in his  ebook short stories THE ADVENTURES OF DOCTOR MARCUS QUIGLEY published by High Noon Press.

And his sixth, RATTLER'S NEST will be out soon.
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Apologies if you comment and I don't reply straight away - my daughter gets married tomorrow and I'll be busy today - (writing my speech!)