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3.2 Early Developments in Electroanalgesia

3.2.1 In the beginning

The beginning of electrical stimulation for pain is coincident with the beginning of electrotherapy itself (Stillings 1975a). Though the origins of magnetism and electricity are lost, animated minerals such as amber, magnetite or lodestone were all known to ancient man. Starting around 9000 BC, bracelets, necklaces, and other appurtenances were used to prevent or assuage headache, arthralgia, and numerous visceral upheavals (Schechter 1971). Paracelus was enchanted with the properties of the magnetic stone and prescribed the lodestone with great abandon. However, much as the 'animated minerals' impressed the ancients, certain fish (Schechter 1971) inspired a yet greater sense of awe. For it is one of the curious symbolic coincidences that medical electricity can trace its origin back to the dawn of the astrological age of Pisces, and moreover, to a fish (Stillings 1973a).

Undoubtedly the first bioelectric phenomenon of which man became aware was the electric discharge of certain types of fish. Throughout the ages, electric organs in several species of fresh and salt-water fish, notably the Torpedo mamorata, Malopterurus electricus and Gymnotus electricus have reached a high degree of development and are capable of delivering a very painful and paralysing shock. These three species happen to be found near the sites of ancient civilizations, and it is probable that their uncanny power has been a source of fear and superstitious conjecture from very primitive times. The earliest man-made records in which electric fish are represented are the fishing scenes depicted on the walls of certain Egyptian tombs, C. 2750 BC. the electric fish represented being the Nile catfish, Malopterurus electricus. However in spite of the fact that its unmistakable lines appear in many early fishing scenes nothing has been extracted from the ancient inscriptions which throws any light on what the Egyptians knew or thought of the electric catfish. There is no doubt, however, that the numbing force of the electric fish was known to the early writers and that the name was synonymous with the effect (Kellaway 1946).

The first known Egyptian work to mention the electric catfish is dated some time in the 4th Century AD, in "The Hieroglyphica of Horapollo". The first chronicler was not concerned with the wondrous powers of these creatures but rather with their nutritive value. That the Hippocratic writings discuss the torpedo and yet make no reference to its strange powers is not remarkable, for these works are characterised by a rational approach to disease and an almost complete disregard for the marvellous and the esoteric. The simple prescription of easily digested torpedo flesh for the undernourished patient is merely another example of the Hippocratic belief in 'natural' therapy, and it stands in sharp contrast to the heavy-handed polypharmacy of succeeding ages (Kellaway 1946).

The torpedo fish was also well known to the fishermen working off the shores of the Mediterranean, before the birth of Christ, and numbing shocks were ample evidence that a torpedo had been ensnared in their nets. The saving and healing powers of fish were acclaimed throughout the medical and non-medical literature of the early centuries of the Christian era. These beliefs doubtless derived from the ubiquitous fish symbolism of the new religion and its founder, the Fisher of Men (Stillings 1973a).

On the basis of what can be garnered from the subsequent writings of Celsius, Oribasius and other compilers, it is apparent that nothing new was added to the medical history of the torpedo after Hippocrates (420 BC) until about AD 46, at which time the Roman physician, Scribonus Largus, introduced the electrical powers of the fish into clinical medicine as a cure for headache and gout. Of all the amazing ichthyic nostrums by far the most remarkable, and perhaps the most rational was the employment of the torpedo's electric discharge for the relief of intractable headache and for gout. This remedy represents the first recorded use of electroanalgesia introduced into clinical practice. Historians characterize Scribonus as a man of sound judgement and high principles, his sole existing work being the 'Compositiones Medicae'. He confesses that in his quest for remedies he gleaned from every likely person he encountered including slaves and wise women. Indeed he lists the electro-ichthyic remedy for gout on the basis of a report that Anteros, a freedman of Tiberius, had been successfully treated for the disease by this means (Kellaway 1946). After the initial excruciating cramp in his foot had abated, he found to his amazement that the pain he had long suffered, from gutta (gout), was completely banished. This event reached the ears of Scribonius Largus and his commentary appeared as follows.

For any type of gout a live black torpedo should, when the pain begins, be placed under the feet. The patient must stand on a moist shore washed by the sea (note precautions to keep the torpedo alive) and he should stay like this until his whole foot and leg up to the knee is numb. This takes away present pain and prevents pain from coming on if it has not already arisen. In this way Anteros, a freedman of Tiberius, was cured. (Scribonius CLXII in Schechter 1971).

Scribonius gives no source, however, for the following description of his galvanic headache remedy and it is possible that he originated it himself (Kellaway 1946).

"Headache even if it is chronic and unbearable is taken away and remedied forever by a live torpedo placed on the spot which is in pain, until the pain ceases. As soon as the numbness has been felt the remedy should be removed lest the ability to feel be taken from the part. Moreover several torpedo's of the same kind should be prepared because the cure, that is, the torpor which is a sign of betterment, is sometimes effective only after two or three" (Compositiones Medicae, XI. in Kellaway 1946).

The Herbal of Pedanius Discorides, 'De re medica', written some thirty years after the 'Compositiones', not only adopts the use of torpedo viva for headaches, (although this has been disputed by some - see Stillings 1973a/1975a), but avers that the remedy may also be successfully employed in prolapsus ani. This clinical application of electric fish is however left to the imagination of the reader (McNeal 1977). Largely through the influence of Discorides these remedies enjoyed a great popularity for many centuries and in fact may be found in herbals and pharmacopoeias up to the end of the seventeenth century, (e.g. in Robert Lovell's (1661) 'Panzooryctologica, sive Panzoologic-omineralogica' p.191). One wonders if the electrotherapeutic treatments for prolapsus ani represent the first intentional stimulation of muscles by artificial means. Nicholas Godinho in 1615 observed that a live torpedo thrown among dead fish seemed to cause them to revive (Stillings 1973a). So it appears that the shock of even a dying torpedo is of considerable intensity and certainly of sufficient magnitude to induce involuntary contractions of semi-striated muscles in dead fish and live animals (Kellaway 1946).

The history of electricity in general medicine often refers to Claudius Galen's (131-201 AD) early use of shocks from the electrical fish to aid gout and other diseases and is on record as follows:

"The whole torpedo, I mean the sea-torpedo, is said by some to cure headache and prolapsus ani when applied. I indeed tried both, and the torpedo should be applied alive to the person who has the headache, and that it could be that this remedy is anodyne and should free the patient from pain as do other remedies which numb the senses: this I found to be so, And I think that he who tried this did so for the above-mentioned reason." (Galen quoted in Stillings 1975/a.

Indian physicians of general medicine, for example, also employed them in all diseases characterized by excessive heat, and Ibn-Sidah, a Muslim doctor of the eleventh century, believed a live electric catfish to have beneficial effects when placed on the brow of a person suffering an epileptic fit (Kellaway 1946). Many others, until the end of the renaissance continued to cite recipes for the torpedo and its ilk. Marcellus Empiricus, Aetius of Amida, Alexander of Tralles, and Paulus Aeginata listed it among the specifics for various cephalgias and arthralgias. Serapion called it Pisces stupefaciens. The Arabians emphasised the virtues of the sleep, which followed the jolting contact with fish. Haly Abbas referred to the latter as the Pisces dormitans. Avicenna and Averhoes thought it efficacious when placed on the brow of persons afflicted with migraine, melancholy, or epilepsy. Persistence of this belief to the sixteenth century is exemplified by Dawud al Antaki's statement that:-

"If the torpedo is brought near, while alive, to the head of an epileptic, the latter will be thoroughly cured... it removes chronic headache, unilateral headache, and vertigo even in desperate cases" (Dawud al Antaki 16C in Schechter 1971/Stillings 1975/a).

So it appears that the use of the torpedo fish continued within general medicine and by the sixteenth century its application had been broadened to include those suffering from migraine, melancholy and epilepsy (McNeal 1977). A 16^th Century Jesuit missionary also described the use of electroichthic therapeutics as practised by the Abyssinians of that period in the treatment of arteries, joints and sinew pain. A seventeenth century traveller, Ludolf Hiob, also reported on the Abyssinians' treatment as follows:

"The Habessines cure Quartan and Tertian Agues with the torpedo, the patient is first to be bound hard to a table, after which the fish being applied to his joints, causeth a most cruel pain over all his members which being done the fit never returns again. A severe medicine which perhaps would not be unprofitable to those that are troubled with gout". (Ludolf Hoib in Kellaway 1946).

Instances of Europeans using electric fish as medical shocking machines are to found in the literature up to about 1850 (Kellaway 1946). Girolamo Cardano in 1551, and Gilbert one-half century later, by clearly differentiating between magnetism and electricity, laid the groundwork for the production and leashing of man made electricity to replace the piscean variety. Gilbert's crude electrostatic induction machines were archetypal of apparatus of that kind in use for the next three hundred years (Schechter 1971). The early years of the seventeenth century also produced two of the most important scientific works ever written: the 'De magnete' of William Gilbert (1600), which first generalised and classified the then known phenomena of electricity; and William Harvey's 'De motu cordis' (1628), describing for the first time (in the West) scientifically, the circulation of the blood (Stillings 1975a). However, Dr William Gilbert (1544-1603), who was also a court physician to Queen Elizabeth and to James the First, apparently never made any significant use of magnetic electricity, but the publication in 1600 of his experiments with the 'loadstone' earned him the title of the 'First Electrician'. Belief in the medicinal properties of magnetism had been voiced by dozens of early writers including Albertus Magnus, Paracelsus, Discorides and Galen. While admitting the possible benefit of powdered loadstone and the possibility of using loadstone for removing arrowheads, Gilbert denied its value for curing headache and dropsy (Stillings 1974). Sixty years after the appearance of Gilbert's 'De Magnete', Otto von Guericke in 1672, was the first to construct an early prototype of an electrostatic generator. He produced electricity by rotating sulfur against the friction of his hand (Stainbrook 1948). This effort being the first controlled artificial production of electricity.

Roughly coincident with the development of this electrotechnology, was the introduction of the practice of acupuncture, imported from Asia. In 1683, Ten Rhyne published his work 'Disser tatio dearthritide:mantissa schematica: de acupunctura...', bringing the first details of oriental acupuncture pain relief to the West. Significant developments in electrical pain relief were found with the application of electricity to acupuncture needles in the early eighteenth century.

3.2.2 Electroanalgesia in the Eighteenth Century

Hauksbee elaborated the crude implement of Otto Von Guerick further into an electrostatic generator, early in the eighteenth century (Stillings 1975a). Haukesbee's generator was a lathe and crank machine specifically designed for the efficient production of static electricity and he replaced von Guericke's sulfur globe with a glass one. His machine attracted the attention of Stephen Gray who has been credited with having laid the foundations for the study of electricity as a science (Stillings 1974). In 1742, Andreas Gordon, a Scotch Benedictine monk, replaced the glass globe with a cylinder and produced the most powerful electrical discharges up to that time (Stillings 1974).

So long before the first treatises on the subject of medical electricity appeared on the continent, Englishmen had been methodically applying electricity to the body and reasoning as to its function in the animal economy (Stillings 1974a). But interest in electroanalgesia shifted from England to France during the middle years of the eighteenth century (Stillings 1974). Artificially generated electricity had begun to find favour with European physicians by the middle of the eighteenth century. Johann Gottlob Krueger, for example, in 1743 as the new professor of philosophy and medicine, first gave his 'Thoughts About Electricity' as a series of lectures in that year. These were published in 1744 and reprinted and 'enlarged by notes' again the following year. In a way, this was the first book on medical electricity, although the book of his pupil, Kratzenstein (1745), was the first to use medical electricity in a title (Licht 1959). Since the publication of this very first book on electrotherapy, the average output has been about five books each year (Licht 1959).

In 1745, Ewald von Kleist constructed the first electrical condenser; an achievement independently duplicated the following year in Leyden by Pieter van Musschenbroek (Stainbrook 1948). They developed a device that would both generate and store large quantities of charge. This was accomplished by the addition of the capacitor to the electrostatic machine. Nolan called this the 'Leyden jar', and used it in his experiments with animals and plants (Kane and Taub 1975). Christian Kratzenstein was probably the first physician to use the electricity from the Leyden jar for therapeutic purposes in general medicine (Stainbrook 1948). The medical applications of electricity, and especially indications for pain now multiplied rapidly (Stillings 1975a). Armed with the electrostatic generator and the Leyden jar, the electrical practitioners really went to work. Paralysis, hemiplegias, epilepsy, kidney stones, sciatica, and angina pectoris were only a few of the conditions that were reported as successfully treated during the years that followed (McNeal 1977). For the invention of the Leyden jar permitted the use of far stronger shocks than the older static machines had been able to deliver, and called attention in a most dramatic manner to the effect of electricity on the human body. Between the years 1750 and 1780 no less than twenty-six papers dealing with medical electricity appeared in the Journal de Medicine alone. An electric shock machine, of the Ramsden type (glass plate style) was installed in the Middlesex hospital in 1767-8, and within the next decade many other hospitals followed suit. Almost immediately after the invention of the Leyden jar, however, the similarity between the shock it delivered and the discharge of the electric fish was pointed out, and physicians were quick to retest the remedial properties of the fish; apparently though, living shocking machines were seen as being more powerful than the man-made instrument (Kellaway 1946).

Storm van s'Gravesande, Governor of Surinam observed, in 1754, that various people who to some degree had gouty pains, and who touched the torpedo had been completely cured two or three minutes after contact. The experiment had been repeated at various times but always with the same result (Kellaway 1946). In1761, a Dutch surgeon, van der Lott related 'experiments', also performed in Surinam with the ferocious Conger eel. It was noted that several black slave boys had been thrown into a tub of water, containing a Conger eel of the black variety, with subsequent improvement in the boys' 'nerve' condition and their fever (Schechter 1971). These remedies were much favoured by Indians and Negroes and they continued to use them until comparative recent times. For example, for many years the colonists of Berbice and Demerara made it a practice to keep two or three living gymnoti in a tank for the use of their plantation workers, who had great faith in the power of the fish's shock to cure rheumatic and paralytic afflictions. The Negroes were not alone in their faith for there are instances on record of European doctors in Guiana using the shocks to treat rheumatism as late as 1850 (Kellaway 1946).

In Britain, Richard Lovett a lay clerk at Worcester Cathedral, claimed in 1755 to be successfully treating many conditions including mental disease by electric sparks and current (Stainbrook 1948). He published an account, the first English-language book on medical electricity, in 1756, of the many conditions for which electrotherapy was recommended, under the title 'The Subtil Medium Prov'd'. John Wesley, the leader of the eighteenth century Methodist reformation, was so impressed by Lovett's electrical treatment that he enthusiastically observed in his own writings, in 1759, that:

"I doubt not but more nervous disorders would be cured in one year by this single remedy than the whole of the English Materia Medica will cure by the end of the century" (Wesley in Stainbrook 1948).

John Wesley's book, 'The Desideratum' 1759, extolled the virtues of electricity in many diseases and its popularity can in some way be measured by the fact that the book went into its fifth edition by 1781. He believed so strongly in the therapeutic properties of electricity that he brought four machines to treat the people of London (Licht 1959). Wesley saw the 'subtle fluid' as the soul of the universe. He advocated electrical therapy for the following conditions:- angina pectoris, bruising, cold feet, gout, gravel in the kidneys, headaches, hysterics and memory loss, pain in the toe, sciatica, pleuritic pain, stomach pain, palpitations and so on. He ends his Desideratum with the following plea:

Before I conclude, I would beg one Thing (If it be not too great a Favour) from the Gentlemen of the Faculty, and indeed from all who desire Health and Freedom from Pain, either for themselves or their Neighbours. It is, That none of them would condemn they not know what: That they would hear the Cause, before they pass Sentence: That they would not peremptorily pronounce against Electricity, while they know little or nothing about it. Rather let every candid Man take a little pains, to understand the Question before he determines it. Let him for two or three Weeks (at least) try it himself in the above-named Disorders. And then his own Senses will shew him, whether it is a mere Plaything, or the noblest Medicine yet known in the World (Wesley 1759).

But compared with his position as the founder of Methodism, John Wesley's interest in electricity and his work as an electrotherapist are virtually unknown. Most of Wesley's applications would seem to many to be farfetched, but it is worth pointing out that Wesley's chief motivation for his promiscuous electrotherapeutics was his belief that this was an extremely effective cure that was, above all, cheap and therefore accessible to everyone (Stillings 1974a). The cataloguing of cases by Wesley in the above book, is evidence of the strictly empirical approach that dominated electroanalgesia in the eighteenth century. The wonder of sudden pain relief by discharging the marvellous electrical 'fire' through the afflicted body parts seemed to obviate any speculations regarding the physiology of the procedures (Stillings 1975a).

In the New World, theoretical electrical science was hardly a major concern of the early settlers in North America. Isolated from their families and traditions and faced with the day-to-day necessities of providing food and shelter, they could not ponder the niceties of natural philosophy. Even later, when the colonies began to enjoy a certain degree of prosperity, American science tended to produce practical inventions rather than theories. Franklin was the exception to this rule, developing the one-fluid theory of electricity that was to hold sway over all others for more than a century. Still, Franklin himself was apologetic about not finding use for his discoveries, and when later did find one, namely, the lightening rod, the Americans considered it his most important scientific achievement (Medronic 1977). Benjamin Franklin, was at times besieged by the lame and sick with requests for electrotherapy. He was master of the science of electricity to that time and also one of the most vocal sceptics of the exaggerated claims of electrotherapists (Stillings 1974). No doubt Franklin's most important contribution to medical electricity was indirect: with his experiments he proved that electricity is an ever-present natural force; he developed the theory and terminology of positive and negative charge as well as the idea that a balance of charge is conserved in nature. Before Franklin, the study of electricity had been primarily a matter of philosophical speculation; after him, it became a science. Franklin removed much of the fear and superstition that had become associated with electricity, and in so doing, he opened the way to serious scientific investigation of electricity in the treatment of disease (Medronic 1977)

Back in Europe, Paris in 1772 saw the Abbe Bertholon using electrical stimulation for foot drop - 'in all such cases the stiffness of the tarsus is inconceivable'. After warming the affected foot, he then applied continuous electrification for three-quarters of an hour, after which the patient was allowed to rest for a few minutes before the procedure was repeated for another three quarters of an hour (Stillings 1975b). In Britain, John Birch, an English surgeon, also in 1772, described the methods by which he applied electrical currents and gave case reports including treatment for injuries, low back pain, gout, constipation and other afflictions (Hymes 1984). However, despite the stories of success, there were many sceptics including Morin in France; Marrigues a surgeon at Montfort in 1773; and Rabiqueau in 1782, an attorney, physics demonstrator, and optical engineer to the King of France; who failed to demonstrate the same degree of success (McNeal 1977). By 1777, more efficient machines were on offer, and as early as 1767/8 a machine had been installed at the Middlesex Hospital in London. St Thomas's, however, would not admit one until 1799, when John Birch finally prevailed:

"It was the usage at St Thomas's Hospital to admit nothing new into practice until seven years experience had given it validity. I have had three times seven years test of the pre-eminent power of electricity and am proud to own, that without this aid, I must have been obligated to perform many more operations" (Birch quoted in Licht 1959).

Meanwhile, towards the end of the 18th and during the first part of the 19th century, many specimens of 'Gymnotus electricus' were exhibited in Europe. Due to the current popularity of electro-therapeutics, or Franklinism as it was then called, many people suffering from gout, rheumatism, and similar diseases flocked to try the curative power of the "natural" electricity discharged by the fish, and an advertisement published in London in 1777 invited one and all to come and be shocked by a "torporific eel" at two shillings and sixpence a time (Kellaway 1946). Learned and large volumes were also written on electricity in the second half of the eighteenth century by Cavallo and Priestley. In each, many pages were devoted to medical uses, for that remained its chief application before 1800. However, even before the nineteenth century began, interest in the application of static electricity in medicine had markedly diminished in Europe. Several magazines that had mentioned progress in electrotherapy each year made no mention of it following 1790. Communication of ideas was relatively slow, and the application persisted a little longer in America, where Gale up to 1805 was permitted to use electricity on several convalescent yellow fever patients in Bellevue hospital (Licht 1959).

3.2.3 "Electro-quackery" in the 18th Century

One might suppose that 'quack' medicine would have tried to carve out a distinctive identity for itself through championing novelty, and, in an age of science and technology, patenting a wave of gadgets to bamboozle the public (Porter 1989). The late eighteenth century indeed, saw the invasion of the field by two notorious charlatans. In the UK, James Graham after meeting Benjamin Franklin in America became an enthusiast for medical electricity and gave lectures, demonstrations and expensive treatments with his 'Celestial Bed' and electrical instruments to ensure fertility (Licht 1959). Case histories from Bath and Bristol in the late 1770's show Graham offering electrical treatments for a spectrum of conditions, from the modish 'nervous diseases' to fevers, rheumatism, gout, deafness and noises in the head. In 1780 at the fashionable Adelphi in London, just off the Strand, he combined lectures and multi-media spectacle with a practice privileging electrical therapy. In this Valhalla of health and fertility, he first unveiled his celestial bed, hired out at £50 a night as a specific against impotence and sterility (Porter 1989).

"Electroquackery" in America had a history all of its own that was as long and colourful as that of legitimate electromedicine. The first great American fraud occurred shortly after the mesmerist cult took Europe by storm in the 1780's. The two bear a certain resemblance to each other in that they both were initiated by well-trained

physicians of great personal appeal, both promised quick and painless cures for disease, and both were mysteriously associated with that strange and marvellous new force, electricity (Medronic 1977). Elisha Perkins, with a medical degree from Yale, in 1796 secured a patent for 'electric' metallic tractors with which he claimed to cure many diseases by sweeping the skin with them. Glowing reports were published in the United States, England and Denmark, and it was not until 1800, when John Haygarth and Falconer of Bath, did a parallel control test with painted wooded tractors that the fraud was exposed. Even so, as has often happened before and since, Perkin's metallic tractors enjoyed considerable popularity for several years more (Licht 1959). For many years after the tractors fell from popular favour, America remained relatively free of 'electroquacks'. But the ideas were not dead, nor had electricity lost its appeal as a curative agent (Medronic 1977). However the grotesque proliferation of junk electrical technology - ozone boxes, masturbation-suppressors, electrical belts, thermal socks, hydraulic pimple squeezers, and the like - was a product of later Victorian 'quackery', (a reflex response, one suspects, to the introduction of laws regulating 'quack' pharmacy). So it would appear that Georgian 'quacks' probably drew upon the medical potential of electricity no more than their regular colleagues (Porter 1989) did. But did the 'quacks' colonise domains of disease relatively neglected by the regulars, such as intractable pain relief? Porter suggests not, for regular medicine did not trouble itself unduly about pain-control, and 'quack' medicine he suggests played not a pioneering role but rather followed in the footsteps of orthodoxy (Porter 1989). Graham's electrical therapy, for example, was integral to his overall medical doctrines and practice, and was, in any case, widely promoted by orthodox as well as 'quackish' practitioners in the last quarter of the eighteenth century (Porter 1989)

 3.2.4 Electroanalgesia in the Nineteenth Century

The nineteenth century was the era of rational positivism - of faith in the individual, in the supreme power of human reason, in science as the key to understanding nature. Better educated and considerably more affluent, the public was no longer so easily taken in by the wiles of 'quackery'. The nineteenth-century charlatan had to sound like a scientist to gain a following. Medicine was changing from a mysterious, widely mistrusted profession into a science that relied on advance in physics and chemistry for its subsequent developments (Medronic 1977).

At the beginning of the 19^th Century, however, the therapeutic use of electricity was contaminated by the prevailing ideas about animal magnetism, and the legitimate medicine of the UK and USA made little use of electrotherapy until after the beginning of the last half of the 19th Century (Stainbrook 1948). Also a clutter of synonyms marred the literature on electrotherapeutics for a couple of centuries. Their equivalents are herewith indicated; franklinization, the application of electricity generated by friction; galvanisation, the application of electricity generated by chemical reaction, the current so produced being designated as galvanic, voltaic, dynamic, continuous, constant, direct, primary, uninterrupted, battery, or pile (actually the galvanic current may be interrupted as well as the continuous) and faradization, the application of electricity generated in a coil of wires adjoining another conductor through which the current traverses. The faradic current, which is necessarily interrupted by the apparatus that produces it, is also referred to as induced induction, inductive, electromagnetic, magnetoelectric, to-and-fro, indirect, or interrupted (Schechter 1971). Allessandro Volta had produced the first battery (Voltaic pile) about 1799 and in 1801 Bischoff claimed to have cured hysterical paralysis and stupor by the application of the direct continuous current (Stainbrook 1948). The Voltaic pile was the first source of electricity which could be produced without effort or regard to the weather, a current with characteristics so different from frictional electricity that for more than a half-century it was called galvanism in distinction from electricity, a name reserved for the static form (Licht 1959).

3.2.5 Electroanalgesia in 19^th Century Britain

By 1804, the galvanic current was being widely used for medical purposes in England for paralysis, tic douloureux etc (Stillings 1974). The London Electrical Dispensary at 16 Bunhill Street, founded in 1793, was able to report in 1820 that more than 8,000 patients had been treated there since its founding. Of these, 4,000 were listed as cured and another 3,000 as relieved. M. La Beaume was virtually the only physician interested in therapeutic electricity in England, but he was better appreciated in France than in his own country (Licht 1959:16). In 1836, Guy's Hospital set aside rooms for an electrical department and put Golding Bird, the instructor in physics, in charge. Because of his scientific standing, he soon had the co-operation of some of the leading clinicians of his time, especially Bright and Addison. However in some hospitals where electrotherapy was used the treatments were still entrusted to the house porter (Licht 1959). Bird gave lectures on medical electricity in 1847, which were published in 1849. These lectures had considerable influence (in the wrong direction!) which probably resulted in the Pulvermacher and Harness electric belts being foisted on a credulous public. These were the days of creativity in electrotherapy and many exorbitant claims often centring on improving the genital organs were proposed (Licht 1959).

Julius Althaus was the first in England to introduce the work of Duchenne, described later, and all other forms of electrotherapy. A graduate of Berlin, he settled in London in 1855 where he soon began to administer electrical treatments at King's College Hospital (Licht 1959). In 1858 he applied 'interrupted' current transcutaneously to peripheral nerves. Althaus claimed like Garrett, that he had experimented with electrical anaesthesia long before Francis in America had popularised it. Whether this claim was true or not, Althaus was the major proponent of electrical anaesthesia in Britain and contributed a great deal to its dissemination (Kane and Taub 1975). He produced the first edition of his 'Treatise on Medical Electricity' in 1859, and it reached its third, very much enlarged and revised edition in 1873. It is with this work that the era of purely empiricistic approaches to electrotherapy comes to an end (Stillings 1974). In subsequent years, the less careful, the less experienced, and the more cautious abandoned the technique of producing analgesia by electricity because of variable and irreproducible results. With its loss of popularity, obscurity followed, and it was necessary for 'local analgesia' to be 'discovered' (or rediscovered) many times after 1858, for example, Guyot in 1878, Araya in 1870-88, and others working in Chile at that time.

3.2.6 Electroanalgesia in 19th Century Europe

The nineteenth century witnessed a widespread irrational use of galvanism and of static electricity in Europe, which continued until the middle of the century when Duchenne and Remak, following Faraday's description in 1831 of electromagnetism, (and his first electric generator), and the subsequent introduction of the induced current, re-established the medical use of electricity on a more rational basis (Stainbrook 1948).

At about this time, something new was added to electrotherapy, which resulted twenty-five years later in the work of Duchenne. In 1821, James Morss Churchill's tract on acupuncture caused considerable renewal of interest (Stillings 1975a). Acupuncture, or the treatment of disease by piercing the skin with needles, is an ancient practice of the Far East. Missionaries brought it back to France with them and Dujardin introduced it into the practice of that country in 1774. Berlioz revived it in 1811, and in 1816 suggested that the medical effects of acupuncture would be enhanced by electricity. Churchill's tract of 1821, also attracted the attention of Sarlandière, who in 1823 decided that all lesions of motion should be treated by (static) electricity and all those of sensation by galvanism. For him, the best way to introduce these currents was through needles. At first he practised electropuncture with both currents, but eventually he used only galvanism. Sarlandière claimed in 1825 that his method "introduces the shock into the very place I wish and this is able to modify the pain, motion or capillary circulation". He was convinced that he helped those with gout and arthritis (Licht 1959). Subsequently, Sarlandière published an extensive work on 'electroacupuncture' which chiefly discussed the great benefits for pain relief resulting from the combination of electricity and oriental needling (Stillings 1975a). He claimed at that time that electrical stimulation "confused" the perception of pain signals (McNeal 1977).

In 1820, Magendie in France, and Purkinje, also employed galvanic current to treat neuralgia, cardalgia and epilepsy (Stainbrook 1948). Later, in 1826, Magendie proved even bolder than Sarlandière and plunged platinum or steel needles into muscles and nerves. He then went on to introduce needles through the eyeball right into the optic nerve and then connected the needles to the poles of a battery. Magendie mentions his remarkable cures but not his failures or accidents (Licht 1959).

The man who probably did most to place electroanalgesia on a sound footing was Guillaume Benjamin Amand Duchenne of Boulogne, who started with the acupuncture of Sarlandière and Magendie in 1833, but who later found that he could admit the electric current less painfully into the body with moistened surface electrodes (Licht 1959), this is also a popular 20th century method of electrotherapy application to be considered in detail later in this thesis. By 1849, Guillaume Duchenne was probably the first to use faradic current in medical research and treatment. Nonetheless the first results of his work was to stimulate in French medicine renewed interest in the galvanic current. Referring to Duchenne's experiments, Recamier in 1851, reported successful improvement in cases of obstinate constipation, abdominal pain and neuralgia's (Stainbrook 1948).

The attention to electrically produced muscular contractions led Duchenne in the 1850's to establish optimal or 'motor' points for electrode placement, a task to which Remak also made important contributions. Remak, in fact, did for German medicine what Duchenne did for medical electrotherapy in France, namely, re-established research in electrotherapy and electrodiagnostics as a valid scientific interest. Remak concluded from his observations on the therapeutic effects of electricity, particularly on the neuralgias, that inflammatory products were the cause of neuralgia and that the pathogenic factor was 'electrolized' by the galvanic current and so therapeutically altered (Stainbrook 1948).

Duchenne's book of 1855, 'De l'Electrisation localisee', was the major electrotherapy event of the century; it established electrotherapy (Licht 1959). In it, he proposed the use of faradic (induced) current, preferring it to galvanic current because of its electrolytic and warming action. He also introduced moistened pads to be used as surface electrodes, finding that they admitted electric current into the body less painfully than dry electrodes (McNeal 1977). The work of Duchenne was repeated in many countries including the USA, Hammond, who for a while was the Surgeon General of the Union Army, used localised electrization on wounded soldiers in a Philadelphia Hospital (Licht 1959).

The analgesic effects of electrostimulation went on to receive wider recognition and acclaim throughout the nineteenth century especially in Europe (Stillings 1975a). In France, Hermel (1844), employed galvanic 'electro-puncture' for the treatment of sciatica and lumbo-sacral neuralgia, using two needles for electrodes and placing the positive needle-pole over the site of the pain. However, the method of 'galvanic acupuncture' was at the time a more common therapeutic procedure in Italy than it was in France, and it was used by Milani and Matteucci in the treatment of neurological diseases such as chorea, the various neuralgias and epilepsy (Stainbrook 1948).

Armed with a better understanding of electrophysiology and new devices such as the battery and the induction coil, electrical practitioners set off in pursuit of cures for diseases. The later half of the nineteenth century might be called the Golden Age of Medical Electricity (McNeal 1977). The Norwegian Engelskjon, in 1855, treated hemicrania by electricity and based his selection of the kind of effective current upon his consideration that there were two essential forms of hemicrania, one being a disease of vasoconstriction and the other, a headache caused by vasodilation. Faradic current was used as an anti-vasoconstrictor, and galvanic electricity was employed as to constrict the pain-producing assumed vasodilation. Indirect support for this rationalisation of the electric therapy of hemicrania was derived from Engelskjon's experience that those cases of hemicrania relieved by the inhalation of amyl nitrite also derived benefit from faradic current (Stainbrook 1948). In the 1860's headaches and neuralgia were frequently given electrical treatment, Brunelli, in the 1867 'Gazetta Medica Italiano' reported a cure of spasmodic facial neuralgia with electricity after 18 sittings. Eulenberg in Berlin (1871) however, more carefully appraised the whole subject of the electrical treatment of the neuralgias and concluded that in the case of centrally produced neuralgia, a true cure by galvanism was doubtful and rare but that palliation of the pain was equally striking and frequent (Stainbrook 1948).

In 1883, the illustrious Wilhelm Erb wrote:

"At the present time we possess in the electrical current one of the most certain and brilliant remedies for neuralgia, although we must admit that much progress has not been made in our knowledge concerning its mode of action in these forms of disease (Stillings 1975a)

Bedwetting and 'sexual neurasthenia' also came within the province of 19^th Century electrotherapy. Dommer in Germany (1898), for example, treated these conditions with reported partial success by passing faradic current between one electrode placed in the urethra and the other, in the rectum! (Stainbrook 1948).

3.2.7. Electroanalgesia in 19th Century United States of America

In America in 1802, Thomas Gale wrote a book, which indicated that the author had been practising electrotherapy since 1776, in New York State, and entitled: 'Electricity, or Ethereal Fire, Considered: 1st. Naturally, as the Agent of animal and vegetable life: 2nd. Astronomically, or as the Agent of Gravitation and Motion: 3rd. Medically, or its artificial Use in Diseases. Comprehending both the Theory and Practice of Medical electricity; and demonstrated to be an infallible Cure of Fever, Inflammation, and other Diseases: Constituting the best Family Physician ever extant'. And that is just the title, the book goes on to extol the virtues of electricity and McNeal suggests that "in spite of Mr Gale, or perhaps partly because of him, the initial flood of enthusiasm for electrotherapy began to wane toward the end of the eighteenth century in the USA and little serious work was attempted or reported during the first third of the nineteenth century" (McNeal 1977). Electricity then, was little used in American medicine in the early part of the nineteenth century. Even so, Brown of Troy N.Y., influenced by the reading of Wesley's 'Desideratum' published a book on the subject in 1817. Although he was able to reproduce strong testimonials from prominent physicians whose patients he had treated, he was unable to influence other American physicians to engage in electrotherapy (Licht 1959). In 1858, Francis, a little known physician from Philadelphia, was the first to describe the relief of dental pain by electricity. He produced analgesia during a tooth extraction by the application of one electrode to the 'offending tooth' while another was held in the patient's hand. He described 164 successful tooth extraction's using 'galvanism', the majority of which resulted in 'no pain'. His 'controls', who received stimulation with the same set-up but with an open switch, did feel pain. A committee, appointed by the Pennsylvania Association of Dental Surgeons to study the use of electricity in dentistry, reported equivocal results, however, and did not recommend his apparatus for general use. Nevertheless. his technique spread almost immediately throughout America to Europe (Kane and Taub 1975). Garrett also recommended these techniques in peripheral neuralgias, hyperalgesias, tic douloureux and jaw ache etc, the electrodes being placed on the edge of the painful site for 3-5 minutes with just a bearable current. Oliver in 1857-8, in Buffalo, attached the negative pole electrode directly to the dental forceps. He also experimented with electrodes placed upon the limbs to produce surgically useful anaesthesia (Kane and Taub 1975).

George M.Beard assisted by Alphonse Rockwell (inventor of the electric chair), wrote their first book on the Medical Uses of Electricity in 1871. This was translated into German and went through ten American editions. Shortly after the publication of their book, Rockwell asked permission to present a paper on the subject before the New York Medical Society but was turned down on the ground that electrotherapy was advocated only by 'quack's (Licht 1959).

In 1872, a Dr Powell said:

There is nothing more striking in recent therapeutics than the change that has grown over the attitude of the profession in regard to the employment of electricity in medicine. Only 10 years ago to announce one's self a believer in electricity as a remedy of positive value was a hazardous thing (quoted in Licht 1959)

By 1875, Rockwell, Byrd and Rockwell published the second edition of their book that summarised the history of electrotherapy with long descriptions of its application. There were multiple chapters of specifics relating to system-related diseases, including asthma, rheumatism, gout, progressive muscular dystrophy, local motor ataxia, neuralgia, migraine and back pain. In addition, afflictions such as alcoholism, a variety of gastro-intestinal tract disorders, and skin diseases were also treated. A specific chapter on neuralgia and low back pain treated by electrical stimulation consisted primarily of case reports. Complications of chronic stimulation, such as scars and ulcerations of the skin, were also noted (Hymes 1984).

With the improvement in quality of static electricity machines in the latter part of the nineteenth century, they became increasingly popular and by the turn of the century most practitioners in America had a static electricity machine in their offices. Typically American was the race to have the 'largest machine in the world' and it was eight feet tall and each of the eight glass plates was five feet in diameter. Electrotherapy reached its peak of popularity towards the end of the nineteenth century and it was used for everything. The journals of the day indicated its use from psoriasis in Moscow to neurasthenia in Philadelphia (Licht 1959).

3.2.8 "Electroquackery" in the 19^th Century

So during the latter part of the nineteenth century, electricity rose to its greatest popularity as a therapeutic agent in Europe and America. But in addition to the dedicated medical men, the charlatan made his appearance too, making wild promises of health and beauty to a gullible public (Medronic 1977). The electric belt, for example, which appeared soon after the 'terrible tractoration' fad had died out, was destined for a less spectacular but much longer career. Originally developed in England in the 1870's, the Pulvermacher Electric Belt spread to the USA and enjoyed a degree of popularity throughout the latter part of the nineteenth century, although they never achieved the notoriety of some other patent devices of the period (Medronic). Interestingly, piscine electricity was still being used in orthodox and 'quack' medicine as late as the 1860's especially in Europe (Schechter 1971). However, the golden age of electrotherapy was coming to an end. Even though, as in 1890, Dr. J.B.Mattison called his colleagues attention to the value of Galvanism and Faradism for the relief of pain - neuralgic and myalgic, "some of the best attested clinical facts that have ever gone into history have been along the line of Galvanism for relief of neuralgic pain". But this appears to be one of the last testimonials to electroanalgesia, for after 1900, the use of electrical stimulation for pain is scarcely even mentioned in the literature, and a giant unexplained gap extends from that time to the present day (Stillings 1975a). However, static electricity retained some of its popularity during the first quarter of the twentieth century and was not fully eclipsed until the advent of short wave diathermy (Licht 1959).

3.2.9 Electroanalgesia in the 20^th Century

The early twentieth century brought many truly marvellous medical advances following the two previous centuries of electrical science which had shown great and continuous progress in the development of instrumentation and theory in electricity, and the credit for many fundamental accomplishments must go to British scientists. Even the colourful, if spotty, history of electroanalgesia revealed many possibilities, since the early inventors had few preconceived ideas about what electricity could or could not do, and in almost every instance a modern application of medical electricity can be traced to its eighteenth-century source (Stillings 1974). Nevertheless the piscean theme of electrotherapy which introduced this chapter remains of interest in the twentieth century, in that many primitive African tribes still employ the shock of Malopterurus electricus as a medicinal agent, a practice which is of very ancient origin and which may perhaps date from the time of the early Greek and Roman invasions of North Africa (Kellaway 1946).

3.2.10 Electroanalgesia in 20th Century Europe

The Golden Age of Electroanalgesia in Europe and Britain ended in the early twentieth century, probably for several reasons; the association with 'quackery' which had been established in the public imagination, the growth of the drug industry which competed for much the same market, and the appearance of x-ray treatments, had produced much more dramatic and documentable results than had earlier electrical techniques such as electrographic diagnostic techniques (Medronic 1977 and Gadsby 1991;1993).

However the following exceptions are recorded: Peterson and LeDuc, (1902-3), rediscovered local electroanaesthesia at the turn of the century. Robinovitch in 1910, recommended local application of current in place of general anaesthesia, even for major operations using a modified LeDuc (interrupted D.C) technique. She found that optimal levels for anaesthesia were: 40V, 40mA peak, with pulse widths of about 1.0msec, and frequencies of 100imp/sec. With this arrangement, and with application of electrodes to appropriate nerves in the leg, several successful major lower limb amputations were performed in 1910 at St. Francis Hospital in Hartford (Kane and Taub 1975).

Hughson in 1922, Shaw in 1924, Guenot in 1953, also recognised the phenomenon of electrical anaesthesia but did not develop the interest further. Guenot recommended its clinical use but apparently did not employ it himself. Following the work of Thompson and Inman in 1933, Paraf in 1948 reported successful therapy in 127 patients with sciatic pain, lumbago, postherpetic neuralgia and tic douloureux. Guenot in 1953, described the work of Perrin, Barnard, LeGo, Presle, Wild and Prolest, all of whom used local and regional electroanaesthesia. Prolest experimented with 50-100 Hz monophasic and diphasic waves, which caused initial 'excitation' and paraesthesias, but soon caused 'inhibition' and raised the sensory threshold to the current (Kane and Taub 1975).

During World War I, there was considerable activity to hasten recovery of peripheral nerve injuries with electro-therapy. But this was a period of slow advance in electrical technology and virtually nothing new developed in the field then for many years (Licht 1959). During the later stages of World War II, and soon after, the emphasis in the field of physical therapy shifted to active participation by the patient and electroanalgesia rapidly diminished in importance, especially in Britain (Licht 1959).

Herin's (1968) study reviews the literature of electroanesthesia in great detail and concludes that, "after weighing the pros and cons of electroanaesthesia, it is a tool which is not yet ready for the practitioner, except the research minded ones who want to use it on experimental animals" (Herin 1968).

Local electrical analgesia as a phenomenon then lay dormant until its republication by Wall and Sweet in 1967 under the impetus of investigations originally initiated to study the effects of 'gating' peripheral input (Kane and Taub 1975). They reported temporarily abolishing chronic pain by electrically stimulating peripheral nerves via electrodes on the surface of the skin; the technique soon became known as 'Transcutaneous Electrical Nerve Stimulation (TENS)' (Wall and Sweet 1967).

3.2.11 Electroanalgesia in 20th Century United States

The early 1900's saw a proliferation of questionable therapeutic applications in the United States of America. This proliferation, coupled with an upsurge of promotion by paramedical and occult practitioners, brought about federal and medical society reaction so that many manufacturers of crude stimulators were forced out of business (Barr 1991). However, by 1900 most doctors in America had at least one electrical machine in their office, and what an array of machines there was to choose from (McNeal 1977). There were machines for pain relief in the arm; a tub for gouty or rheumatic feet; a stool for electricization by sparks; an electrostatic bath with cephalic douche; electrical poison extractors; Dr Karshner's electric baths with vaginal tubes and fountain; the solenoid cage; electrical belts - especially the Pulvermacher belt, described earlier, for weak and debilitated conditions of the generative organs; Dr Scott's Electric Hair Brush, at 1 Dollar, to prevent baldness, falling hair, dandruff and headache; electric tonics and so on. But electrotherapy again rapidly diminished in importance in the United States of America where it was regarded by some as old-fashioned (Licht 1959).

3.2.12 "Electroquackery" in the United States - Revisited

It might be assumed that, with the passage of time, the increase in knowledge and knowledgeable people would make it increasingly difficult for a charlatan to establish himself, and to some extent this was true. Between the time of Elisha Perkins and Albert Abrams, more than a century later, there had not been a truly successful fraud in Medical Electricity in America. However at the beginning of the 20th Century, Albert Adams, a distinguished American professor of psychiatry recommended electrical treatments, based on a diagnosis which could be made only by the use of his secret machine, for which he charged physicians high prices in addition to a monthly royalty. The secret machine was analysed in 1925 and found to contain an electromagnet and a single turn of wire on a wooden disc but there was no complete circuitry. By 1925, it was estimated that hundreds of physicians in the United States alone were exponents of the system and as the books on Abrams treatments were also published in England, it is fair to assume that there were a few exponents here also (Licht1959). Since the 1900's, a few manufacturers sold treatment machines such as the "Electreat" directly to consumers. These instruments became popular, and all imaginable types of claims, including the cure of cancer, were ascribed to these units, but the FDA banned their sale in the early 1950's (Hymes 1984).

3.2.13 Electroanalgesia in China

So far the study has centred on the US/Europe axis, but no discussion on pain relief and electroanalgesia would be complete without a review of Chinese Traditional Medicine and their alternative theory of medicine, especially the use of acupuncture and electroacupuncture techniques. For acupuncture has been used in the treatment of pain and a variety of illnesses in China, and more widely in the Orient, for more than 2000 years. The practice of acupuncture is based on a theoretical system different from our understanding of human anatomy and physiology in the West and has developed through experience and observation. Stimulation of selective acupoints situated along 'meridians' is believed to restore bodily functions by promoting the flow of 'vital energy called 'Qi' throughout the system. Advances in technology in the twentieth century brought about new developments in acupuncture in China too and an electric current was first used with acupuncture in 1930. Although the early history of electroacupuncture may well be European (after Sarlandière 1825), it recurred in China in the late 1950's and spread widely throughout the country (Lu 1980). In 1958, Chinese physicians and anaesthesiologists began to apply acupuncture analgesia for major surgery. It was not long before electrical stimulation was found to be more convenient and effective than manual stimulation in many cases and the technique is in wide use today (Lu 1980). Electro-acupuncture is also a rapidly developing field in the West too, as technologically minded orthodox and unorthodox practitioners rise to the occasion (Fulder 1989). This aspect of electroanalgesia will also be considered in detail later in this study.

 3.2.14 Contemporary Electroanalgesia

Following the demonstration by Wall and Sweet (1967) that stimulation of peripheral nerves in man produced control of pain, there was a new interest in stimulation as a potential pain control technique (Long 1991). Interest in the clinical application of electrical stimulation appeared higher then than at any other time in its history, wrote McNeal in 1977. Thousands of patients are being treated for chronic pain with both permanently implanted and nonsurgically applied devices and without doubt, electrical stimulation will continue to play an important role in the future course of the field of medicine (McNeal 1977). Shealy and Long in the USA, were pioneers in this area of pain relief, initially using surgically implanted dorsal and anterior column electrodes for stimulation and later developing TENS in response to the observation that pre-operative TENS seemed to reduce the perception of pain almost as well as the dorsal column implant (Hymes 1984). While the original goal of transcutaneous stimulation was screening of patients for spinal cord stimulators, it became apparent quickly that stimulation of the skin was often sufficient to provide pain control alone (Long 1991).

The participation of private industry was an important factor in the early development of this rediscovered modality of TENS and these companies in the USA supported many of the studies. Secondly, the technical features of the instruments that were developed by these companies were an extremely important part of these investigations (Hymes 1984). The decade of the 80's produced more than 200 varieties of TENS and biofeedback devices and dozens of other pain-relieving modalities and techniques. Hymes writing in 1984 commented "it is interesting to note that electrotherapy had little use in the mainstream of modern medicine in the first 70 years of the 20th century in spite of the well-documented use of this modality in previous times". As such, little clinical research and few publications have appeared in the medical literature until recently. Basic research, however, was being conducted (see Licht 1967) who reviewed the available historical literature and reported a comprehensive study citing more than 900 references. For the 20-year period from 1967-1987, Nolan (1991) compiled a bibliography of over 600 papers concerning TENS from clinical and basic science literature. In addition special journal issues and several books have been devoted to this subject (Barr 1991) and since 1967 an increasing number of orthodox and unorthodox health professionals have employed electroanalgesia, (TENS/EAP), in a wide range of acute and chronic pain conditions.

The efficacies of TENS/EAP, as a modality in the treatment of pain has now been well established, even if it cannot be seen as a panacea. It would appear that contemporary orthodox and unorthodox practitioners, over the last two decades, have rediscovered a modality that has been in the hands of various medical/other practitioners for the last two centuries or more. Although electrical stimulation was commonly used in the 18th and 19th centuries, reports were mainly anecdotal, often as case studies, and probably would not have withstood the critical, objective analysis demanded by 20th Century medical science. Albeit contemporary medical science itself is said to have only verified around 15% of its own contemporary clinical interventions (Smith 1991), partly because only 1% of the articles in medical journals are scientifically sound and partly because many treatments have never been assessed at all (Eddy quoted by Smith 1991). The main aim, therefore, of this programme of study is to strengthen the scientific bases of both conventional and unconventional electroanalgesic techniques as we head for the twenty-first century.

3.2.15 Discussion

From the mid 1700's, when investigators began meticulously to explore the effects of static electricity on the human body, to this century, when physicians routinely use electrical instruments to diagnose and heal, electromagnetism and the life sciences have been inextricably linked. Ideas from the past catalyze many of today's technological advances. But for all those ideas transformed into reality, many more still await exploration. Amongst them are important inventions waiting to be rediscovered, such as D'Arsonval's high frequency general anaesthesia. Electroanalgesia has itself been alternatively hailed as a panacea and damned as 'quackery' over more than two centuries of European and American medicine. So why did the 19th and early 20th century physicians reject these treatment methods? Quen (1975b) doubts that this rejection was based on simple selfish economics. Requiring no scientific training or knowledge, their widespread acceptance might have threatened the livelihood of the practising physician. It was also a confirmed observation, in the history of electroanalgesia and other methods such as 'Perkins Tractoration', that electroanalgesia and 'Tractoration' relieved patients, who had not been relieved by conventional treatments of the day (Quen 1963, 1964, 1975a). What factors in the medical and scientific communities determined the responses to these methods. Gunther Stent (1972) suggests that some scientific discoveries are premature because their implications cannot be connected by a series of simple logical steps to canonical, or generally accepted knowledge. This would appear to be the case with electroanalgesia and 'Tractoration' theories that provided no acceptable rationale for the medical communities of the time. It appears that electroanalgesia was met with 'selective inattention' by the medical scientific community as in the case of Perkinism, or as nineteenth century Western acupuncture, receiving no theoretical explanation, was ignored by those who needed a 'normal science' rationale to allow themselves to acknowledge or use it. We see then, a group psychological mechanism for rejection of those methods that do not provide an explanation. The absence of a scientifically orthodox theory of the mode of action, and the consequent implication of the imagination or the placebo effect are the dominant traits of these therapies according to the 19^th and early 20^th Century scientific communities (see also Saks 1995 for discussion of explanations). A situation which still persists to this day in respect of many alternative and complementary therapeutic interventions, if not in the case of conventional electroanalgesia in the form of TENS, it certainly does in the form of electroacupuncture as an alternative or complementary therapy. It is also an interesting observation that electroanalgesia and other treatment methods, rejected by the scientific medical community, provided relief and palliation for many people who did not benefit from 'normal science' medical treatment. Something was utilised, with apparently remarkable therapeutic efficacy, by the patients who responded to these anomalous methods (Quen 1975b). So today, the effects of electricity on the body are again the subjects of considerable interest among orthodox and unorthodox physicians and engineers alike (Medronic 1977) and that this interest is the motivating force behind this study. For if nineteenth century medicine was unable to distinguish between fallacious theory and therapeutic fact, are we really better able to do so at the end of the twentieth century? If not, which appears to be the case at the time of writing, then we must produce and publish strong research evidence to support, or reject, the theories and efficacies of electroanalgesia before we lose the methods yet again. I end this chapter with a quotation from D'Arsonval (1851-1940 - inventor of a high frequency unit) that I believe is as true today, nearly 100 years later, as it was then:

"I am convinced that the therapy of the future will employ heat, light, electricity and agents yet unknown. Toxic drugs shall cede their place to physical agents the employment of which at least has the advantage of not introducing any foreign body into the organism" Arsene D'Arsonval, 1896.

In the course of reading for, and in the preparation of this section of the thesis, it became of increasing interest that the pioneering work of the Rev John Wesley had made a considerable contribution to electroanalgesia, not only in the eighteenth century but in the influence he had on its development in the centuries that followed. This early application of electrotherapy was well documented in his books, 'The Desideratum', 'Primitive Physick' and also in his Journals. These writings show more than just a passing interest in this new treatment of 'electrifying' his sick followers. The next section (3.3), as a history of medicine case study, is devoted entirely to Wesley's pioneering work of healing the sick with an emphasis on his therapeutic use of electricity.

3.2 Early development in Electroanalgesia
3.3 John Wesley and eighteenth century health care: A history of medicine study
3.4 Mechanisms of pain
3.5 Mechanisms of electrical pain relief
TENS Electrode Placement Chart
EMS Electrode Placement Chart