On The Treatment of Blindness and Deafness Resulting from Cerebro-Spinal Meningitis
70 Art. VI. BY THE CONSTANT CURRENT OF ELECTRICITY. :Author: Edward C. Mann, M.D.
Supt. Sunnyside Retreat for Diseases of the Nervous System, Dipsomania and the Opium Habit, Member New York Neurological Society; New York Medico-Legal Society ; Am. Ass’n for cure of Inebriates, etc. Fort Washington, N.Y. City, U.S.A.
The blindness and deafness resulting from cerebro-spinal meningitis have generally been considered by the profession as incurable. We have been led to the study and investigation of this class of cases by a very fortunate result obtained recently in a case of blindness, which will be detailed further on, in which, by patience and perseverance in the treatment, sight was finally restored; and the results gained in this case, by the use of the constant current, have led us to believe that these cases are not all incurable, and, in giving the results of our investigations, we hope that others may be induced to adopt a like treatment with equally happy results. The catalytic effect of the galvanic or constant current of electricity is such as to remove organisable deposits in all other parts of the body, and to modify nutrition as no other agent can do, and we have long thought that such an action could be excited on brain tissue ; and we have, in many instances, seen cases of grave brain exhaustion, bordering on insanity, yield rapidly to galvanisation of the brain, with the chloro-phosphide of arsenic as the only internal remedy. We had been successful in freeing an immovable uterus from the organised effusion which had bound it down after cellulitis, and had rendered it freely movable in the pelvis. The success obtained in this case first led me to hope for results in galvanisation of the brain where the effect of cerebro-spinal meningitis has been to produce both blindness and deafness by the effect of the inflammatory products in the corpora quadrigemina, and on the auditory nerves, by impairing their nutrition. In cerebro-spinal meningitis, we have an exudation in the sub-arachnoid space. The convexity of the cerebrum is affected, but the base of the brain most injuriously so. The exudation is the greatest about the chiasm, in the fossa of Sylvius, at the base of the cerebellum and in the fissures of the cerebrum. The nerves from the base of the brain are completely bathed in the exudation. In the spinal cord we find vascularity of the dura mater, sometimes between the dura mater and arachnoid an effusion, and generally there is purulent effusion between the spinal arachnoid and the pia mater. The tissue of the pia mater is implicated. In this, as in other inflammations, we have an exudation of liquor sanguinis and migration of white blood-corpuscles and alterations in the nutrition of the inflamed tissue.
These alterations in nutrition are characterised by an exaltation of the nutritive functions of the cellular elements of the tissues involved in the inflammatory process. We have consequently cell-proliferation. These new cells are not properly developed, are prons to take on retrogressive changes, and if they form a new tissue it is poorly organised. It is supposed that this increased nutritive activity which characterises this tissue change is due to the stimulation of the cellular elements by the liquor sanguinis exuded from the blood vessels, and also perhaps partly by impressions conveyed to them through the nervous system. As changes of a more chronic nature we have a more gradual increase in the connective tissue (neuroglia) and atrophic and degenerative changes in the various new elements. We bave then in the cases I speak of, where the special senses have become involved as the result of cerebro-spinal meningitis ?a diseased condition of the nerves of sight and hearing, caused by disturbance of nutrition; the result of the products of inflammation. The question now is, can we so improve the nutrition of these nerves, and remove these disturbances of nutrition, so as to restore lost or impaired sight and hearing ? I claim that we can, and that the catalytic action of the constant current of electricity has a sufficient power to modify and improve the nutrition of these nerves when properly and intelligently applied. I was much surprised when a patient of mine told me recently that an eminent oculist told her that she could allow an electrician to use the induced or Faradic current for her child who was deaf as a result of cerebro-spinal meningitis. “Naturally enough she got nothing but a very disagreeable effect, with no benefit whatever. There is a great difference between the chemicai and catalytic effects of the galvanic and the Farradic current. The former current possesses them in a very high degree?the latter has no chemical action in solution of salt, water, solutions of albumen, etc. Ten years ago I commenced the study of electro-therapeutics, and can to-day, from almost daily experience with both currents in nervous diseases, state positively my firm belief in what Niemeyer stated in 1870, that ” in the constant current we have a means more powerful than any other* of modifying the nutritive conditions of parts that are deeply situated,” I most firmly believe that other physicians can get the same results I have obtained in these cases with patience and perseverance. The most interesting case was that of blindness so complete that all the oculists of eminence in the country, to whom the patient’s parents had taken her, had pronounced the case absolutely incurable, and said that the young lady must remain blind. The young lady was referred to me by an eminent specialist in nervous diseases, and after carefully examining her, I told her parents that I would take her under treatment, and do what I could. My treatment consisted in hypodermic injections of nitrate of strychnia ; phosphorus and cod-liver oil interually, and the constant current of electricity applied several times a day at first, for a few moments each time. I soon improved the general health, which was much impaired, but worked carefully and patiently on the case for some weeks with no appreciable benefit to the sight, so far as I could discover. One day, about eight weeks or more after her admission here, I was applying the constant current through the optic nerve, she exclaimed : ” Dr Mann, I can see a flash of light.” Up to this time the retina had not responded at all to the constant current. She described the light as appearing like heat lightning we witness in summer. From this time on there was steady improvement, and at the end of about six months’ treatment I sent my patient home so well that she could see to thread a cambric needle. My idea of the pathology of this was that we had optic nerves bound down by an organised exudation and that this disappeared, and that the atrophic and degenerative changes also disappeared as the effect of the constant current of electricity. I know of more than one case where parents of children suffering from blindness and deafness have been told so positively by oculists that they could do nothing for them, and they were incurable ; that they had absolutely refused to trouble themselves any further about the matter. I think I am the first to suggest a cure and treatment by this method of using the constant current, as I have searched the literature of the subject without finding even a hint at the possibility of its being done. In closing I would say, that of course we do not know how many cases of this kind we can cure. I do know, however, that they are very troublesome to the general practitioner who has not the time to devote to them. We shall most gladly receive any such cases here from the profession as we deem worthy of especial study and investigation, and patient and careful treatment; and we hope and believe that the results of our investigations in this direction will lead us to be able to class blindness and deafness, resulting from cerebro-spinal meningitis, among the curable forms of diseases of the nervous system. There are also chronic congestive states of the brain which tend to mental disorder if not checked, where, in my opinion, we have in the constant current of electricity the very best therapeutical means of cure. The vessels of the dura mater and pia mater, and of the brain itself are habitually dilated in these cases, and we have to get a tonic contraction of these vessels if we are to cure our patient. By using the positive pole at the level of the first cervical vertebra, and the negative at the level of the superior ganglion of either of the cervical sympathetic nerves we can get this result.
Two things must be observed in order to be successful. 1st.
Long continued treatment; and 2nd. the avoidance of an injuriously strong current. It is well to use a slowly interrupted galvanic current to promote vascular contraction. Patients usually experience relief which they describe as very marked, after each application. The subject of electrisation of the brain and its membranes is a matter of deep practical interest to all who are interested in nervous diseases, and the practical application of the constant current in physiological medicine is as yet in its infancy, and results show that the tissues intervening between the brain and the electrodes, do not offer very much difficulty in application.
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