Fig 9 Electrotherapy by means ofa voltaic pile (by courtesy ofthe Wellcome Trustees). Therapeutic Galvanism. In 1800 Allesandro Volta invented the voltaic pile,.
Volume 70 September 1977
635
Section of the History of Medicine President F F Cartwright FFARCS
Meeting 2 February 1977
Paper Electrical Apparatus used in Medicine before 1900' by Nicholas Anthony Cambridge (Middlesex Hospital Medical School, Mortimer Street, London WIP 7PN) Torpedo fish, amber, and magnetic rings were used by the Ancients for electrical treatment. However, most of the electrical apparatus used in medicine, was invented in the last three hundred years. This essay traces the development of knowledge about electricity, and the various discoveries which enabled electrical apparatus to be designed for use in medical treatment until 1900. The first person known to have been cured by electricity was Anthero, a freed slave of the Emperor Tiberius Claudius Nero Caesar who ruled ancient Rome from AD 14 to AD 37 when he was murdered by suffocation. Anthero's enjoyment of liberty was marred, however, by his sufferings from gutta (probably gout). One day whilst walking the seashore he stepped on a flat, medium-sized fish called a torpedo, which is now known to be capable of delivering a substantial, sometimes lethal, electric shock of approximately 100-150 volts d.c. One effect on Anthero, after the initial numbing had subsided, was to free him of his gout. Thus it appears that the torpedo fish was the first electric therapeutic agent. John Hunter (1728-1793), anatomist and physiologist, studied the torpedo fish thoroughly (Hunter 1773). These investigations were undertaken at the request of John Walsh who, working at La Rochelle, had shown that the 'shocks' produced by the torpedo were caused by the generation of electricity (Walsh 1773). These electric organs of fish were a great curiosity in the ' Awarded Student's Essay Prize, presented by Dr F F Cartwright, President of the Section of the History of Medicine during the 1976/77 session
eighteenth century, which was a post-Newtonian era where an interest in natural science and electricity were potentially explainable by Newtonian matter theory. It was a popular pastime at social gatherings to see how many people could be included in a circuit to transmit the shock from a single torpedo fish. Hunter made several dissections of the electric organs of the torpedo fish. A female torpedo fish which was dissected by Hunter may be seen in the Hunterian Museum at the Royal College of Surgeons, London (Fig 1). It is a dorsal view with the head end at the top. On the right a superficial dissection has been made to show the upper surface of the electric organ and its shape and position in the body. On the left the electric organ is still further exposed, and the nerves supplying it are shown by the removal of the muscles which concealed them. The four nerves are branches of the facial, glossopharyngeal and vagus. The electricity of fishes was not the only electric phenomenon in the natural environment of the early civilizations to be exploited. Lightning was too intractable to be used. However amber, which was able to be electrified by simple rubbing, was supplied in the form of pills to combat himorrhages, nausea and catarrh. It was even burnt to prevent the spread of plague. Finally, magnetic rings were sold at a high price to those suffering from rheumatism. Human Electrification It was not until 1551 that an Italian physician and
mathematician, Gerolamo Cardano (1501-1576), explained the behaviour of amber and magnetic rings (Benjamin 1895). He was the first to differentiate between the electricity of amber and the magnetism of magnetic rings. In theorizing over the cause of their behaviour, he introduced a theory of electricity which departed from the views of Renaissance philosophers (with their principles of sympathy, occult qualities, &c.) and came closer
636
Proc. roy. Soc. Med. Volume 70 September 1977
Fig 1 Female torpedo fish (by courtesy of the President and Council, Royal College of Surgeons, London)
Fig 2 Otto von Guericke with thefirst continuous electrostatic generator (by courtesy of the Wellcome Trustees)
to the theories of the newly emergent mechanical philosophy. Cardano's work made little impact upon the practice of the medical world, but it was not until over 100 years after his death, that any change took place in the application of electric phenomena in medicine. The change, when it came, originated
tractions, probably by electrostatic charges. He also observed in another patient that during electrification their heart rate increased. In the following year, 1745, von Kleist invented the Leyden phial or jar, today recognized as the first capacitor. This device had the property of storing an electric charge produced from an electrostatic generator. The device consisted of a glass jar containing impure water and carried on its outer surface a covering of metal. Experimenters were now able to combine the electrostatic generator and Leyden phial for therapeutic electrification.
in an accidental discovery. Otto von Guericke (1602-1686), working in Magdeburg, Germany, invented the first continuous electrostatic generator in 1660 (Fig 2). It consisted of a sulphur sphere which was mounted on a wooden frame and rotated by means of a crank. By placing his hand on the sphere he received an electrostatic charge, which was similar to that produced by rubbing an amber rod. By 1746 people started to experiment further with electrostatic charges (Nollet 1746).
Early Therapeutic Electrification In 1744 Christian Gottlieb Kratzenstein, Professor of Medicine at Halle and a practising physician, was able to free the contracted little finger of a female patient by producing muscular con-
Franklinism Electrification was also practised by Benjamin Franklin (1706-1790), American physicist and statesman. He employed his apparatus, which incorporated an electrostatic generator and Leyden jar, to give spark and shock treatments. This became known as Franklinism. Franklin, however, thought his patients obtained as great a benefit from walking to his house as they did from the electrification.
Section of the History of Medicine
637
Fig 3 John Wesley's apparatus (by courtesy of Pitkin Pictorials, London) Fig 5 A device for passing charges through a tooth in order to stop the pain of toothache (by courtesy of the Wellcome Trustees)
Fig 4 Adam's electrostatic machine in use for medical treatment (by courtesy of the Wellcome Trustees)
At the same time another well-known figure, John Wesley (1703-1791) the founder of Methodism, practised Franklinism (Turrel 1938). John Wesley's apparatus (Fig 3) can still be seen at the Wesley Museum, London. On the right is a Leyden jar and on the left an electrostatic generator. Fig 4 shows how the apparatus was used (Adams 1785). One of the 417 books Wesley published was entitled 'Primitive Physic'. It states that electrifying in a proper manner cures such things as blindness, cramp, deafness, gout, headache, palsy, rheumatism, sprain and even toothache. Fig 5 shows a
device for passing electric charges through the tooth to treat toothache (Cavallo 1777). Another well-known figure to employ electricity in medicine was Jean Paul Marat, the French revolutionary who was a physician (Hill 1957). The Middlesex Hospital was probably the first hospital to purchase an electrostatic machine. Fig 6 shows the entry made by the Weekly Board on Tuesday 10 November 1767, when Mr Wyatt acquainted the Board that from his own knowledge several very bad cases had been cured and others greatly relieved by electricity. By the following week an electrical apparatus was procured for five guineas. In 1790 a quack, James Graham of Edinburgh, proclaimed himself the President of the Council of Health. Fig 7 shows an advertisement by Graham for his 'Grand Electrical Apparatus' (Graham 1790). One of his inventions was the 'celestial bed'. It was an elaborate structure supported on forty glass pillars, and equipped with a variety of electrical devices. It was guaranteed to provide immediate pregnancy for the barren. An alternative name used by Graham was the 'medicomagnetico-musico- electrical bed'. Interest in electrification, both genuine and fraudulent, barely outlasted the eighteenth cen-
638
Proc. roy. Soc. Med. Volume 70 September 1977
tury, for new discoveries were made, which promised more effective therapeutic methods.
Fig 6 Entry of the Weekly Board of the Middlesex Hospital (by courtesy of Mr Winterton and the Middlesex
Hospital)
tk,Si4t., Prku 3,. ;1 P Rw c fO4 triig, Abftd, and iaeiu&aaI State of
Galvanism Muscles of frogs' legs had been stimulated to contraction by the action of a metallic couple well over a century before Luigi Galvani (1737-1798), Italian physicist and anatomist, practised his famous experiments in the 1790s, but the phenomenon was misunderstood and dismissed as a purely mechanical reaction. Galvani observed that the frogs' legs twitched when given a shock from the output of an electrostatic machine. He also observed that frogs' legs contracted when suspended by metal hooks upon an outside metal railing. He thought that the contact completed a closed circuit, causing a muscular contraction by shorting out the natural animal electricity (Hoff 1936). One of his chief opponents was Allesandro Volta (17451827), Italian physicist, who in 1792 put before the Royal Society that the muscular contractions were due to quantities of electricity inherently generated at the junction of dissimilar metals. This new galvanic electricity bred its own charlatans: such as Elisha Perkins, for example, who invented 'metallic tractors' for which he took out an American patent in 1796; his son Benjamin followed with an English patent in 1798. These were shaped something like the limbs of a pair of compasses, the points being of different metals, and were employed by being stroked over the surface of the skin; the idea of course being derived from Galvani's discovery of the action of metallic couples in producing muscular contraction. 'Perkins calipers' was caricatured by James Gillray in 1801 (Fig 8). Perkins was not insulted at all, and thought it very good propaganda. He even sent Gillray a cheque for his services.
:AL PRACTICE EXHIBITED; xccolfNr
* W fog TRSAIrm2f DisVaT ss, TKMtPLR 0F HIALTH I A;ND
f MIM% -'MAVRL5s DIScowIaRIS, IMPEOftIMiITS.
ELECTRICAL APPARATUS,
SII
Fig 7 James Graham's advertisement for his 'Grand Electrical Apparatus' (by courtesy of the Wellcome Trustees)
Fig 8 Caricature by James Gillray: 'Metallic Tractors' (by courtesy of the Wellcome Trustees)
Section of the History of Medicine
639
was the first to use static electricity in the treatment of convulsive and spasmodic disease (Addison 1837), and Golding-Bird used it for treating IA amenorrhcea (Golding-Bird 1841). Golding-Bird also used an induction coil generator using Faraday's principle. The method used for general faradization is illustrated in Fig 10. The patients, deprived of most of their clothing, sat with bare feet upon a sheet of copper which was connected to one pole of the generator, whilst the other electrode took the form of a wet sponge or the operator's hand applied to Fig 9 Electrotherapy by means of a voltaic pile (by the appropriate part of the body (Althaus 1873). courtesy of the Wellcome Trustees) In 1847 Duchenne de Boulogne (1806-1875), French neurologist, presented a communication to the Academie des Sciences in Paris. Fig 11 shows Therapeutic Galvanism In 1800 Allesandro Volta invented the voltaic pile, Duchenne faradizing the frontalis muscle of a which was the first battery. It consisted of alternate patient, possibly suffering from facial paralysis. In silver coins and zinc discs, each separated by a 1855 he published his famous 'L'Electrisation piece of water-soaked card, and was capable of Localis&e'. For this and subsequent work, which he delivering a distinct electrical shock. Galvanism, termed 'local faradization' to distinguish it from by means of a voltaic pile, was used for patients the general faradization of other workers, Duchsuffering from deficiencies of vision by applying an enne also designed his own generator (Duchenne electrode to the eye socket (Fig 9) (Carpue 1803). 1871). He is remembered as the founder of modern This form of treatment was also used for patients electrotherapy. suffering from deficiencies of hearing, for the alleviation of sciatica and rheumatism and in Electrocautery certain paralytic conditions. It was also thought We owe the development of the electrocautery that Galvanism might prove an effective agent in apparatus and most of its prototypes to Albrecht dissolving gallstones. However, subsequent experiments upon stones removed by surgery showed that at best only small erosions of the stones could be achieved, and the method was never attempted upon a human patient. Though the effect upon stones was disappointing, the effects upon muscles could be highly dramatic. The experiments previously carried out upon the muscles of animals were soon repeated on corpses by such people as Professor Aldini (Morning Post 1803). However, electrotherapy by Galvanism went into disrepute, partly due to the exploitation by quacks, and it was not until the discoveries of Michael Faraday that a new form of electricity became available.
Faradization In 1831 Michael Faraday (1791-1867), English physicist and chemist, invented the first transformer, and treatment using this type of electricity was called 'Faradism'. Faraday's work was also of interest to the medical profession during his lifetime; for example, Faraday gave a course of fourteen lectures on electricity in 1835 to the medical students of St George's Hospital. In 1836 Guys Hospital established within its walls an 'electrical room' where such eminent English physicians as Golding-Bird (1814-1854), Addison (1793-1860) and Gull (1816-1890) studied the effects of electricity on disease. Addison
F1G. 1i26.-General FaradiRation.
Fig 10 Generalfaradization (by courtesy of the Wellcome Trustees)
640
Proc. roy. Soc. Med. Volume 70 September 1977
During that time he employed the capillary electrometer, devised by Gabriel Lippman in 1872, to record heart currents in a manner that could be photographed. He used his pet bulldog, Jimmy, for his work. With his apparatus Waller made the first recording of electrical activity associated with the human heart beat. Initially he called the record an 'electrogram', but a year later in a lecture at St Mary's Hospital Medical School he referred to the records as 'cardiograms'. The word 'electrocardiogram' was introduced later by Einthoven, who first employed the string galvanometer as a method of electrical recording in 1903. Waller had the honour to be one of the first two consultant physicians appointed to the National Heart Hospital in Westmoreland Street, London.
S 5 wF dt
S
i4 7_ ~~~~~X-rays In December 1895, Professor Rontgen published jhis discovery of the extraordinary effects of the rays from a Crooke's tube when electrically excited. Probably no other scientific discovery has ever excited so much widespread and immediate attention. In his Rede lecture, given at the University of Cambridge on 10 June 1896, J J Thompson opened his subject as follows:
Fig 11 Duchennefaradizing the fronatalis muscle (by courtesy of the Wellcome Trustees)
Theodor von Middeldorpff of Breslau, who published a systematic treatise on the subject in 1854. A box of galvanocautery instruments designed by Middeldorpff can be seen in the Wellcome Collection in London (Fig 12).
-
Electrical Illumination Methods in Medicine or the illumination and visual examination of accessible body cavities, dates back to 1807, when the first recorded attempt was made by Phillip Bozzini (1773-1809) (Pearlman 1949). The first electrically illuminated cystoscope was devised by Max Nitze (1848-1906) in 1876, and used a platinum wire. By 1877 the idea had been developed so far that a working apparatus for the examination of the urethra, bladder and larynx was constructed.
Endoscopy,
Electrocardiography In 1887 Augustus Desire Waller (1856-1922) demonstrated the electromotive changes accompanying the heart beat in man (Waller 1887). Waller worked at St Mary's Hospital Medical School between 1884 and 1903, starting as a lecturer in physiology and ending as head of the department.
Fig 12 Galvanocautery instruments and apparatus designed by A T von Middeldorpff (by courtesy ofthe Wellcome Trustees)
Section of the History of Medicine 'Professor R6ntgen, of Wurzburg, at the end of last year published an account of a discovery which has excited an interest unparalleled in the history of physical science. In his paper, read before the Wurzburg Physical Society, he announced the existence of an agent which is able to affect a photographic plate placed behind such substances as wood or aluminium, which are opaque to ordinary light. This agent, though able to pass with considerable freedom through light substances, such as wood or flesh, is stopped to a much greater extent by heavy ones such as the heavy metals and the bones; hence, if the hand, or a wooden box containing metal objects, is placed between the source of Rontgen rays and a photographic plate, photographs such as those now thrown on the screen are obtained.'
Summary The Ancients had at their disposal torpedo fish, amber and magnets. It was not until the sixteenth century that ideas on the strange behaviour of amber and magnets were put forward. The eighteenth century saw the application of Newton's theories of matter and the introduction of the electrostatic machine, Galvanism and Volta's battery. In the nineteenth century there was extensive application of electricity in medical practice, with the development of electrocautery apparatus and illuminated cystoscopes, the pioneering of the electrocardiogram and the discovery of X-rays. REFERENCES Adams G (1785) An Essay on Electricity. 2nd edn. London
641
Addison T (1837) Guy's Hospital Reports 2, 493 Althaus J (1873) A Treatise on Medical Electricity. Longman, London; p 394 Benjamin P (1895) The intellectual Rise in Electricity - a History. Longman, London; p 249 Bird G (1841) Guy's Hospital Reports 6, 84-120 Carpue J C (1803) An Introduction to Electricity and Galvanism. London Cavallo T (1777) A Complete Treatise on Electricity. London Duchenne G B A (1971) A Treatise on Localised Electrization and its Application to Pathology and Therapeutics. London Graham J (1790) The Guardian of Health (Pamphlet), Newcastle-uponTyne Hill 0 (1957) British Journal ofPhysical Medicine 20, No. 5, 100-102 Hoff HE (1936) Annals of Science 1, No. 2, 157-172 Hunter J (1773) 63rd Volume of Philosophical Transactions; pp 409-489 Morning Post (1803) 22 January Nollet A (1746) Essai sur l'electricite des corps. Paris Pearlman S J (1949) Quarterly Bulletin of Northwestern University Medical School 23, 332-354 Turrel W J (1938) John Wesley - Physician and Electrotherapist. Blackwell, Oxford Waller A D (1887) Journal of Physiology (London) 8, 229-234 Walsh J (1773) Works of John Hunter. Vol 4, pp 398-408
