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To the Editor: The review of electroconvulsive therapy (ECT) in the
Journal1 was timely. The origins of
this form of treatment may, surprisingly, be traced back to
Scribonius Largus, who, in AD 47, treated persistent headaches by
applying the electric torpedo fish of the river Tiber to his patients'
heads (the Emperor Claudius numbered among his
patients).2
The generation of seizures (by either chemical or electric means) to
bring about a therapeutic effect has appeared in various guises
through the centuries: - In the 16th century in Switzerland,
Paracelsus was using seizures induced by camphor to treat
psychosis.3
- In 1745, Dr Jean LeRoy in France was treating patients with static
electricity2 (this is unlikely to have
produced a true, therapeutic convulsion, but may have helped in some
psychosomatic conditions). Dr Robert Whytt of London described
similar efforts in his 1751 book on the "nervous, hypochondriac, or
hysteric".4 (For many years, a popular
fairground show had young couples "plighting their troth" with the
girl standing on an insulated platform, with one hand on a capacitor,
her swain standing on the earth, so that when they bent towards one
another a violent spark would pass between their puckered
lips.5)
- The London Medical Gazette, in 1785, published an account by
Dr William Oliver of two patients in whom he had induced fits with
camphor taken by mouth, and around the same time Carl von
Weickhardt in Germany and Dr Leopold von Auenbrugger in
Vienna reported a number of similar cases.3
- In 1917, electrotherapy was revisited with the use of faradic
(non-convulsive) therapy by Dr Leonard Yealland in London to
treat men suffering "shell-shock".6
- In the early 1930s Dr Lazlo von Meduna of Budapest
produced fits using "Metrazol" (pentylenetetrazole, a central
nervous system stimulant) on the basis of the dubious observation
that epilepsy was rare in those with schizophrenia.7 (He had first
tried using camphor, but found it too hard to control.)
- Drs Ugo Cerletti and Lucio Bini induced convulsions by
electricity in 1938. (While collecting pigs' brains from the Rome
abattoir for biochemical studies, they noted that some animals were
merely stunned by electric shock, while some had convulsions.
Earlier Cerletti had used a mouth-rectum circuit in experiments with
dogs, but this sometimes killed through its effect on the heart --
an observation still misleadingly brought forward from time
to time in arguments against ECT.)8
In the 20th century the risk associated with ECT has been reduced (eg,
with the introduction of curare in 1940) and the technique refined
(with development of variations such as "maintenance ECT" and
"unilateral ECT").1 What has remained
constant is the generation of seizures to bring about a therapeutic
effect. Plus ca change, plus c'est la meme chose.9
Gerald Milner
Psychiatrist
Townsville, QLD
DRGERRYMILNERATbigpond.com
- Wijeratne C, Halliday GS, Lyndon RW. The present status of
electroconvulsive therapy: a systematic review. Med J Aust
1999; 171: 250-254.
-
Alexander FG, Selesnick, ST. History of psychiatry.
London: Allen and Unwin, 1956: 282.
-
Dubovsky SL. Electroconvulsive therapy. In: Kaplan HI, Sadock BJ,
editors. Comprehensive textbook of psychiatry. 6th ed. Baltimore:
Williams and Wilkins, 1995: 2129.
-
Whytt R. (1751) Observations on the nature, causes and cure of those
disorders which are commonly called nervous, hypochondriac, or
hysteric: to which are prefixed some remarks on the sympathy of the
nerves. In: Becket and du Hondt, editors. The works of
Thomas Whytt. 3rd ed. London: Becket and du Hondt, 1767.
-
Rowlandson T. The third tour of Dr Syntax in search of a wife. London:
Rudolph Ackerman, 1821.
-
Yealland LR. Hysterical disorders of warfare. London:
Macmillan, 1918.
-
Meduna L J. New methods of medical treatment of schizophrenia.
Arch Neurol Psychiatry 1936; 35: 361-363.
-
Cerletti U. Old and new information about electroshock. Am J
Psychiatry 1950;107: 87-91.
-
Alphonse Karr. Les Guepes (Paris) Jan 1849: 305.
©MJA 1999
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