We have come a long way with device therapy: historical perspectives on antiarrhythmic electrotherapy

The history of device therapies is long and fascinating. In the beginning, there is not simply the anatomy and physiology of the heart, but also analysis of the pulse, which indicates the activity of the heart. The analysis of the (peripheral) pulse as a mechanical expression of heart activity goes back several millennia. In China, in 280 BC, Wang Shu He wrote 10 books about the pulse. The Greeks called the pulse "sphygmos"; thus, sphygmology deals with a theory of this natural occurrence. In Roman times, Galen interpreted the various types of pulse according to the widespread presumption of the time that each organ in every disease has its own form of pulse. The growing clinical importance of electrical cardiac stimulation was recognized and renewed as Zoll in 1952 described a successful resuscitation in cardiac standstill by external stimulation. Meanwhile, millions of patients with cardiac arrhythmias worldwide have been treated with pacemakers in the last 40 years. The concept of a fully automatic implantable cardioverter defibrillator system for recognition and treatment of ventricular tachyarrhythmias was first suggested in 1970. The first implantation of the device in a human being was performed in February 1980. Further developments involved atrial and atrioventricular defibrillators, radiofrequency ablation, laser therapy, and advanced antiarrhythmic surgery. Since 1990, there has been a growing interest in using cardiac pacing as additional treatment in severe cardiac failure. Recent reports have suggested that intervention with left ventricular or biventricular pacing may be helpful for a subgroup of patients with congestive heart failure. Despite encouraging (preliminary) acute and short-term results, pacing strategies for heart failure still are limited and currently regarded as investigational. Advances in the field of therapeutic application of pharmacologic and electrical tools as well as alternative methods will continue as rapidly as before and provide us further significant aid in taking care of patients.

[Surgical treatment of Parkinson's disease in Poland in the last century]

Surgery of Parkinson's disease started in the middle of the last century. At the same time this treatment was introduced in Poland. Choróbski removed Broadsman's area 4 through craniotomy. In 1961 Liszka in Kraków introduced the stereotactic procedures, thalamo- and pallidotomy. This type of surgery was soon introduced in two other neurosurgical centers. For the next several years treatment was mostly pharmacological. However, stereotactic treatment was used in patients poorly tolerating drugs. In the meantime first attempts were made at implantation of fetal substantia nigra, with good results. At the end of the century in several patients electrostimulators were implanted. In the last century all known methods of surgical treatment were applied in Poland.

A historical perspective of the popular use of electric and magnetic therapy

OBJECTIVES

To review the history of the therapeutic use of static electric and magnetic fields and to understand its implications for current popular and medical acceptance of these and other alternative and complementary therapies.

DATA SOURCES

Comprehensive MEDLINE (1960-2000) and CINAHL (1982-2000) computer literature searches by using key words such as electricity, magnetism, electromagnetic, therapy, medicine, EMF, history of medicine, and fields. Additional references were obtained from the bibliographies of the selected articles. In addition, discussions were held with curators of medical history museums and supplemental searches were made of Internet sources through various search engines.

STUDY SELECTION

Primary references were used whenever possible. In a few instances, secondary references, particularly those requiring translations of early texts, were used.

DATA SYNTHESIS

The use of electric and magnetic forces to treat disease has intrigued the general public and the scientific community since at least the time of the ancient Greeks. The popularity of these therapies has waxed and waned over the millennia, but at all times the popular imagination, often spurred by dynamic and colorful practitioners of pseudoscience, has been more excited than the medical or political establishment. In fact, a pattern seems to reappear. In each era, unsophisticated public acceptance is met first with medical disdain, then with investigation, and, finally, with a failure to find objective evidence of efficacy. This pattern continues today with the public acceptance of magnetic therapy (and alternative and complementary medicine in general) far outstripping acceptance by the medical community.

CONCLUSION

The therapeutic implications of applying electrical and magnetic fields to heal disease have continually captured the popular imagination. Approaches thousands of years apart can be remarkably similar, but, in each era, proof has been lacking and the prevailing medical establishment has remained unconvinced. Interest persists today. Although these agents may have a future role in the healing of human disease, their history and a minimal scientific rationale makes it unlikely that the dichotomy between the hopes of the public and the medical skepticism will disappear.

Electrical stimulation with bone and wound healing

Electrical stimulation has been used to heal fractures and ulcers and reduce pain through modulation of local body processes. It has been recognized that mechanical forces and bioelectricity have an intimate relationship in influencing the production of bone. Science has developed techniques to affect change in the electrical charge of fractures to positively affect the healing process. Electrical stimulation, through invasive and noninvasive applications, has produced excellent results in the treatment of nonunions and ulcer care. A thorough review of the electrical properties of bone and soft tissue and the influence of electrical stimulation on healing is presented here.

The Tulane Electrical Brain Stimulation Program a historical case study in medical ethics

In 1950 physicians at Tulane University School of Medicine began a program of research on the use of electrical brain stimulation that would span three decades and involve approximately 100 patients. Initially, electrical brain stimulation was used to treat of schizophrenia, but later it was applied to a variety of other conditions. Throughout its history the Tulane research was well publicized in both the professional and lay literature, and for almost twenty years, with rare exception, these accounts were laudatory. However, in the early 1970s this work began to draw sharp public criticism. Despite its public and controversial nature, the Tulane electrical brain stimulation program has received relatively little attention from historians. This review recounts the history of the Tulane program with particular emphasis on the ethical propriety of the work. Factors that shaped the historical context in which the Tulane experiments were conducted are discussed.

Electrical bone graft stimulation for spinal fusion: a review

Although electrical stimulation to aid bone fusion is well established in the treatment of long-bone fractures, its use as an aid in spinal fusion is not as well documented. This article presents the history and scientific basis of electrical stimulation to aid bone fusion and extensively reviews the clinical literature. It is intended to provide an objective review of the indications and limitations of electrical stimulation to enhance spinal fusion and to serve as a reference source for further study.

Irving S. Cooper (1922-1985): a pioneer in functional neurosurgery

Irving S. Cooper (1922-1985), the son of a salesman, worked his way through high school, college, and medical school to become one of the pioneers in functional neurosurgery. He developed several novel techniques for the surgical management of Parkinson's disease and other crippling movement disorders. A keen interest in the physiology of movement disorders was kindled by his doctoral research and continued during his neurosurgical training. He began to apply this knowledge to surgical practice in 1952 when he began his faculty career as Assistant Professor of Surgery at New York University. At the time, surgical treatment of parkinsonian tremor focused on various techniques used to interrupt the pyramidal tract. During a subtemporal approach for a cerebral pedunculotomy, he inadvertently injured and, subsequently, was forced to occlude the anterior choroidal artery. Much to Cooper's surprise, following emergence from anesthesia the patient's tremor and rigidity were abolished without any residual hemiparesis. This serendipitous observation, together with Meyer's earlier work on the role of the basal ganglia in motor control, helped focus surgical efforts on targets within the basal ganglia and, subsequently, within the thalamus to alleviate the movement disorders associated with Parkinson's disease. While at New York University, Cooper developed chemopallidectomy and, later at St. Barnabas Hospital in the Bronx (1954-1977), he used cryothalamectomy as a surgical technique for primary control of tremor in patients with Parkinson's disease. Cooper authored many original papers on surgical techniques and several textbooks on the lives of patients afflicted with Parkinson's disease and other crippling movement disorders. Although considered controversial, this fascinating and complex neurosurgeon made significant contributions to this field.

"Professor" William C. Wilson and his Actina electric pocket battery for curing ocular disease

PURPOSE

To investigate the activities of the firm that manufactured and sold the Actina, the leading example of ophthalmic quackery in the era of the founding of the American Academy of Ophthalmology.

METHODS

Advertisements for the Actina in turn-of-the-century newspapers and magazines were studied, and additional related investigations were undertaken at leading historical societies in the United States and at the headquarters of the American Medical Association.

RESULTS

The Actina was widely advertised as a cure for most of life's ills, particularly those of the eye and ear. Its manufacturers claimed that electrical properties were the mechanism of the Actina's alleged therapeutic effects. However, research has shown that the instrument had no electrical properties, its manufacturers had no medical training, and that the Actina was useless as a therapeutic agent.

CONCLUSIONS

The firm that manufactured the Actina was located in Kansas City and was at the zenith of its success when the first meeting of the American Academy of Ophthalmology was held there in 1896. Its fraudulent activities sparked a continuing public outcry that contributed to the passage of the Pure Food and Drug Act of 1906. The American Medical Association's Investigative Bureau was a major factor in the firm being put out of business in 1915 by the federal government.

Peripheral nerve stimulation for restoration of motor function

This review paper discusses the use of electrical stimulation to restore function after upper motor neurone type of paralysis. It describes the basic physiology of electrical stimulation, the electrophysiology and biomaterials associated with using metal electrodes to deliver charge to living tissue, and also the adverse effects of stimulation. The central concepts of electrode applications, stimulus parameters, muscle fatigue, and stimulation control are covered. Next, a survey of clinical applications is made with focus on upper and lower limb applications. A concluding section mentions the current status of commercial products available for stimulation.

Capital, profession and medical technology: the electro-therapeutic institutes and the Royal College of Physicians, 1888-1922

Images

[Medical treatment abroad. Why Bjørnstjerne Bjørnson died in Paris 1910]

The Norwegian poet and playwright Bjørnstjerne Bjørnson (1832-1910), Nobel prize laureate in literature 1903, died in Paris. He had suffered from angina pectoris for a few years and had difficulties in walking because of thrombophlebitis in his right leg. In 1909, he had received electrotherapy from a French physiologist, Dr. d'Arsonval, in Paris and felt rejuvenated after the treatment. In May 1909, while undergoing spa treatment in Larvik, he had an apoplexy which left him with a left hemiparesis, presumably due to a thrombosis of the right internal carotid artery. He became bedridden, developed focal epilepsy and was unable to participate in the national cultural activities that used to be part of his life. He then decided to return to Paris for another series of electrotherapy. He was brought to Paris in the Royal Danish railway carriage, and was received at the border as an official guest of the French republic. The electrotherapy machine was installed in his room at Hotel Wagram, where he stayed for several months while receiving treatment. However, his health deteriorated during the treatment and he died in Paris in April 1910.

[250 years ago: the origin of electrotherapy exemplified by Halle]

Experiments started in 1743 by a working group at the university of Halle marked the beginning of efforts to incorporate electricity into clinical therapy. Very soon this resulted in knowledge that was also taken up elsewhere, leading to a period of intensive research. The creative suggestions that originated in Halle were authored, among others, by Johann Gottlob Krüger, Christian Gottlieb Kratzenstein and Johann Joachim Lange. Their experimental and clinical findings were accompanied by deliberations on the mechanism of action of electrotherapy on which they reported in detail. Due to adverse circumstances this initially leading position occupied by Halle faded out already shortly after the middle of the century.